Let me know if that money actually shows up. I think that if I told my biller (whose compensation I bonus on % collections, clean claims, bad debt, and A/R's) that I want to start doing procedures with unlisted codes on Medicare patients she'd kick me in the nuts.Medicare uses the unlisted code and around $12,500 today but I have closer to $10,000 listed in some emails from last month. HOPD will make $3000-$6000.
Private insurance depends on contracting but is typically slightly better. They stated physician fee is typically 3x a single level kypho.
Dont need discogram. Its vertebrogenic. Histopath supports nerve innervation of the endplates. This is back by basic science and histopath. Not voodoo even though everyone would like to assume and hope it is so they can act their baseline pessimistic selves.How do you diagnose vertebrogenic back pain? Do you have to do a discogram to rule out discogenic back pain first? And run through facets, ESI etc.
Posted on their website: https://www.relievant.com/clinical-evidence/Please post. Both RCT.
Just saying that there is anRCT tells us... next to nothing.
Read the intracept study closely though - maybe I’m wrong but it looks like they largely ignore the results of the sham group because sham did nearly as well as the intervention. They admit as much in the discussion, and the results section presents very little data comparing the outcomes vs sham."check pubmed" can lead to a lot of confusion. and for pretty much every positive study out there for pain medicine, there will probably be a negative study.
relying on articles posted on a marketing website is likewise suspect.
the study does appear promising and well done. only concern the authors did not address is that it is still an industry funded study (of course, given its initial investigative role). further studies could confirm (or disprove) the purported benefits.
It is certainly a novel approach. I agree with the problem concerning the sham group, as well as the fact that it was an "open label" study. Placebo response is increased in open label studies, as well as with procedures for which the patient is paying more money (not the case in this particular instance).Im glad you dissected it. Theres two sides to every article. If you apply your concept to pain as a whole - why do we practice interventional pain at all... I would love to see what perfectly pristine evidences based services you offer in your practice so I can adapt.
truthIt is certainly a novel approach. I agree with the problem concerning the sham group, as well as the fact that it was an "open label" study.
Given that the concept is somewhat unique, I think the best thing is to go an learn more about it. Even if one is not going to perform such procedures, it is good to get some education about it.
After this discussion, I contacted the bunch to get to a training course. I am always skeptical of new procedures, but try to learn about them, as even if you don't incorporate such treatments, you can walk away with some "pearls".
Ah so you're looking for a theory as to why something might work...Sorry- how come vertebroplasty/kyphoplasty doesn't cure back pain? The cement would kill any viable neuronal elements, yet people still have pain.
Addtionally, when have you seen a patient that has one isolated degen disc? Lastly, there is little correlation between the MRI and pain. How do you select patients?
Why didn't IDET (when done on severely degen discs, such that the endplate was heated) cure back pain?
I actually think this could work
BUT, there is no way to know who the appropriate patients would be. Selection criteria is too vague, but i cant think of any way to improve the selection criteria.
I'd guess maybe 1 in 3 patient you try it on would like the results.
Can only do 3 levels at once.
Say l4/5/s1. The procedure will
be very long if you do more
than that. The machine only has one port and it is 15min/ablation
Okay- thanksThey certainly said the bone will be dramatically harder but did not mention pedicle fracture.
You access similar to a kypho but you want to be as medial as you can safely be when you enter the vertebral body. You want your RF probe to be no more than 50% anterior and midline for final position. It is a bit similar to trying to do a uniped kypho but you can get away with being a lot sloppier in the kypho.
It will be a month before I do any.
What do you think about pulsed Rf now?It is a very novel approach. Again, I think this is one, given that this approach has really never been done before, that we should carefully evaluate, go to the courses, and see how more data looks.
I agree that the patient selection could be tough, as there is not a "test block" or neurological sign that would point to this treatment. I would imagine that in patients with refractory back pain in whom PT has failed, have negative test blocks, and have modic I and II changes over 1-2 segments would potentially be candidates. Again, time will tell......................... or not.
Let's see how this one unfolds and keep an open mind, while maintaining healthy skepticism. That is one reason I thought working at the VA would be pretty cool- it would be easier to conduct clinical trials, as you don't need pre-auths for new treatments.
PS- I did a lot of IDET and pulsed rf, ect and was made to look like a fool. Thus my enthusiasm is checked a little more now than in the past. I get pretty psyched up about new treatments, but like a kid before Christmas morning, have to slap myself and be patient.
Is the company making it hard to train as with drg/Abbott?