CAT 1 Code for MILD: Implications for Pain?

[drusso]

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[Agast]

FYI for people who are in the WISER states, there are exclusion criteria

Most of my patients also have neural foraminal stenosis and anterolisthesis…

 

[swamprat]

G and H kinda suck. D I agree with but if they also have severe central idk why it shouldnt be tried. also M is weird, what if they have CRPS and then develop LSS later in life

 

[SgtThunderfistMD]

How many RVU's are these codes worth? Magically everyone who lived and died by this sham procedure will stop doing it starting January 7th.

 

[Ducttape]

8 wRVU. still more than ESI.

by that measure, every procedure we do can be considered a sham procedure by someone else.



in terms of those criteria, ill probably stop offering ESI prior to MILD and go straight for MILD, which might drive up utilization...

h is idiotic as these elderly people have spinal stenosis because of ligamentum hypertrophy and degenerative disease with grade 1 spondylolisthesis.

b and c are almost contradictory. someone has axial only back pain and cant have MILD. someone else has radicular symptoms and cant have MILD.


but its all okay. more CBT for everyone!

 

[paindoc007]

No esi within 2 months ? Does that make any sense to anyone here??

 

[Ducttape]

$$$.

i postulate some people might have this paradigm:

ESI. bill for it. 3 weeks later, MILD. do haphazard job. then a week later SCS trial 2 leads. then discharge to spine surgeon or PCP.

 

[geauxg8rs]

$$$.

i postulate some people might have this paradigm:

ESI. bill for it. 3 weeks later, MILD. do haphazard job. then a week later SCS trial 2 leads. then discharge to spine surgeon or PCP.

Need an si joint injection. Also toss in some opioids and urine screen.

 

[thecentral09]

can these be done in an office setting?

 

[drusso]

can these be done in an office setting?

We've done cash cases in the office. Our state permits moderate sedation in the office/OBL. Payers won't pay for it in site of service 11

 

[mdo1738]

can these be done in an office setting?

Payers won’t pay if not in a facility. Medically speaking, they absolutely could be. I do most of mine with local only.

 

[MitchLevi]

That list is freaking insane!

If you have neurogenic claudication, you virtually always have all the other "stuff we get when we get there," AKA the stuff you get with aging which almost always includes foraminal and lateral recess stenosis, and prob some degree of spondy.

 

[Status Sciaticus]

Those requirements are going to effectively kill this procedure.
How are they expecting 60+ years olds to have ONLY LFH and axial back pain?

I cant even understand the rationale for indwelling intrathecal pump? Its not even in the same plane!

How many RVU's are these codes worth? Magically everyone who lived and died by this sham procedure will stop doing it starting January 7th.

That may be true, but its not because of its effectiveness, but rather because of all the BS hoops that they will have to jump through.

 

[BobBarker]

Yes, I had a case scheduled in early January that I canceled.

 

[Taus]

Yes, I had a case scheduled in early January that I canceled.

I suspect many will not be as on top of this as you and there will be heavy rac audits like kypho

 

[Ducttape]

id like to see them add a caveat that this can be offered in spite of restrictions if no other surgical alternatives are available.

 

[pmrmd]

MILD was removed from WISeR. I can just imagine those meetings with the Stryker reps.

 

[Agast]

MILD was removed from WISeR. I can just imagine those meetings with the Stryker reps.

Source?


Edit: nm I see version 3 of the PDF specifically says it is delayed