Cash procedure Medicare

[bedrock]

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I have a Medicare patient that slipped a traumatized two facet joints. Acute injury so I think a facet injection would be enough. She doesn’t want to do RFA for same reason.

Can she pay cash for a facet injection instead?

Technically steroid injections aren’t covered, so it shouldn’t break the law if she is charged cash for this correct ?

 

[knoxdoc]

I have just done cash pay for MC cervical facet injections with no issue. That being said, you CAN do lumbar facet injections if you do the two sets of MBB and if you can document a reason the patient cannot undergo RF (pacer, A/C, spinal hardware, etc).

 

[PMROralBoards]

I have just done cash pay for MC cervical facet injections with no issue. That being said, you CAN do lumbar facet injections if you do the two sets of MBB and if you can document a reason the patient cannot undergo RF (pacer, A/C, spinal hardware, etc).

Are you sure you have to do the two sets of MBB prior to a diagnostic and therapeutic facet injection? In the past I just wrote whatever contraindications to the RFA and had it approved

 

[mdo1738]

Are you sure you have to do the two sets of MBB prior to a diagnostic and therapeutic facet injection? In the past I just wrote whatever contraindications to the RFA and had it approved

Agreed, my LCD is that way. No need for useless MBB if there is contraindication to RFA, go straight to therapeutic FJI instead.

 

[callmeanesthesia]

Agreed, my LCD is that way. No need for useless MBB if there is contraindication to RFA, go straight to therapeutic FJI instead.

Have you checked recently? My LCD (Noridian) definitely does require MBBs prior to FJI. I agree it’s stupid. OTOH, hey, we get paid 3 times instead of one. I guess that’s Medicare’s way of saving money.

 

[bedrock]

Agreed, my LCD is that way. No need for useless MBB if there is contraindication to RFA, go straight to therapeutic FJI instead.

There are Medical contraindications and there are just patient wishes. This lady might not need RFA for several years because she only just slipped and irritated her facets recently.

If I was her I’d happy to pay $400 cash to just do IA facets and be done with things.

 

[knoxdoc]

Are you sure you have to do the two sets of MBB prior to a diagnostic and therapeutic facet injection? In the past I just wrote whatever contraindications to the RFA and had it approved

Yes, unfortunately.
Palmetto LCD: "Therapeutic facet joint procedures are considered medically necessary for patients who meet ALL of the following criteria:
a. The patient has had 2 medically and reasonable diagnostic facet joint procedures with each one providing a consistent 80% relief of primary pain AND
b. Subsequent therapeutic facet joint procedures at the same anatomic site results in at least consistent 50% pain relief for at least 3 months AND
c. Documentation for why the patient is not a candidate for RFA"

 

[Taus]

Only cash Medicare I’ve done is SI rfa

What if you slipped a little steroid in the joint during mbb…

 

[PMROralBoards]

Yes, unfortunately.
Palmetto LCD: "Therapeutic facet joint procedures are considered medically necessary for patients who meet ALL of the following criteria:
a. The patient has had 2 medically and reasonable diagnostic facet joint procedures with each one providing a consistent 80% relief of primary pain AND
b. Subsequent therapeutic facet joint procedures at the same anatomic site results in at least consistent 50% pain relief for at least 3 months AND
c. Documentation for why the patient is not a candidate for RFA"

There’s no clear definition of what medications need to be in a diagnostic facet joint procedure. Correct me if I’m wrong please, but why not just put steroid and minimal lido in? Seems like it is the right thing for the patient and then future facet injections could just be steroid.

 

[Ready_User_1]

Offering a cash option for a procedure that would be denied by medicare or any insurance is illegal?

 

[MitchLevi]

Come on dude. You know the answer to this Q

 

[Ducttape]

There’s no clear definition of what medications need to be in a diagnostic facet joint procedure. Correct me if I’m wrong please, but why not just put steroid and minimal lido in? Seems like it is the right thing for the patient and then future facet injections could just be steroid.

Previously, It might have gotten clawed back by Medicare in a future audit, but the newer guidelines did not specifically limit injection to LA only.

If you do used steroids, in order to do future injections, the patient are supposed to report that this injection reduced pain by80% for the appropriate duration - ie 3 months - to get future injections approved...

 

[CarabinerSD]

I have just done cash pay for MC cervical facet injections with no issue. That being said, you CAN do lumbar facet injections if you do the two sets of MBB and if you can document a reason the patient cannot undergo RF (pacer, A/C, spinal hardware, etc).

You get MBB approve even if patient already has spinal hardware / fusion there?

 

[oreosandsake]

if medicare doesn't pay for the procedure then they can sign an ABN. can find form on internet

 

[Agast]

I have done “small joint injections” for a patient whose insurance did not cover thoracic facet procedures, as a one time deal. Doing it once will probably not cause major blow back, but the patient needs to understand you are not repeating it.

 

[drusso]

Offering a cash option for a procedure that would be denied by medicare or any insurance is illegal?

Imagine if we lived in a country like that this November when you go to vote. #electionshaveconsequences