Cryoablation

[painisfear]

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Is anyone here performing cryoablation on a regular basis?

What conditions respond best?
Average duration of benefit?
What system are you using (Iovera etc)?
What are the advantages compared to thermal ablation in your opinion?

 

[willabeast]

Very long time ago I acquired a cryoprobe gratis. The problem I remember is the probe was huge. Advantage is limited post procedure neuritis. Stopped using it as pulsed RF is technically much easier. Hopefully the cryoprobes are much smaller now.

 

[Snowmen96]

I've used Iovera a few times. Works well for things where it doesn't really matter if you move a little like genicular nerves but the probe is pretty large and unbalanced (all the weight is in the handle). Doing something much more risky like intercostal nerve ablation wasn't fun because of that.

The rep mentioned that they are about to publish a study comparing cryoablation to RFA for lumbar facets, and that cryoablation came out on top. This is interesting if true (and if it's a good study) but the issue is that you can only do a single lesion at a time and it's like the tip of the cannula would move during the ablation.

 

[cowboydoc]

Is anyone here performing cryoablation on a regular basis?

What conditions respond best?
Average duration of benefit?
What system are you using (Iovera etc)?
What are the advantages compared to thermal ablation in your opinion?

Less frequent use of late because of worsening insurance coverage, but have done >1500 cases. Mostly knee, but have done shoulder, intercostal, genitofemoral/ilioinguinal and various nerves in residual limb pain many times.
All Iovera. 3 to 6 months if it works.

For me, the advantage is doing it in clinic, markedly cheaper than going to HOPD Center and much faster for me. U/s not fluoro is better for peripheral nerves including knee. Relatively less damage to the nerve, relatively lower risk, at least conceptually.

 

[1 Up]

I've used Iovera a few times. Works well for things where it doesn't really matter if you move a little like genicular nerves but the probe is pretty large and unbalanced (all the weight is in the handle). Doing something much more risky like intercostal nerve ablation wasn't fun because of that.

The rep mentioned that they are about to publish a study comparing cryoablation to RFA for lumbar facets, and that cryoablation came out on top. This is interesting if true (and if it's a good study) but the issue is that you can only do a single lesion at a time and it's like the tip of the cannula would move during the ablation.

Not to mention the duration of relief is ~3 months, as opposed to 6-18 months with RF.

 

[Laryngospasm]

Less frequent use of late because of worsening insurance coverage, but have done >1500 cases. Mostly knee, but have done shoulder, intercostal, genitofemoral/ilioinguinal and various nerves in residual limb pain many times.
All Iovera. 3 to 6 months if it works.

For me, the advantage is doing it in clinic, markedly cheaper than going to HOPD Center and much faster for me. U/s not fluoro is better for peripheral nerves including knee. Relatively less damage to the nerve, relatively lower risk, at least conceptually.

Why can’t you do rfa in clinic?

 

[cowboydoc]

Why can’t you do rfa in clinic?

Need fluoro.

 

[SpineandWine]

Less frequent use of late because of worsening insurance coverage, but have done >1500 cases. Mostly knee, but have done shoulder, intercostal, genitofemoral/ilioinguinal and various nerves in residual limb pain many times.
All Iovera. 3 to 6 months if it works.

For me, the advantage is doing it in clinic, markedly cheaper than going to HOPD Center and much faster for me. U/s not fluoro is better for peripheral nerves including knee. Relatively less damage to the nerve, relatively lower risk, at least conceptually.

Regarding Iovera. I have a hard time drumming up cash business on this (my market is lots of medicare/medicaid).
Is there any insurance coverage for Iovera?
Is there medicare LCD that allows this? Or is it one of those they don't check and they could do a clawback?

 

[cowboydoc]

Regarding Iovera. I have a hard time drumming up cash business on this (my market is lots of medicare/medicaid).
Is there any insurance coverage for Iovera?
Is there medicare LCD that allows this? Or is it one of those they don't check and they could do a clawback?

My outfit gets a prior auth on everything. I can't say there's no chance at a claw back, but I don't get a green light on this without checking a PA. Insurance coverage has tanked over the last 5 years for this, but I'd say I can do it about 1/3 of the time I want to offer it. I do more on medicare than private insurance for sure.

 

[Agast]

Iovera came sniffing around my ASC. I guess they lowered their product price.

I found a CMS LCD for Noridian that specifically said they should be using a T code and not the RFA codes. Does anyone know how much that T code reimburses?


CPT Codes:
• 0440T (upper extremity lovera)
• 0441T (lower extremity lovera)
• C9809 (cyroablation needle) - reimbursement is payor-dependent

Article - Billing and Coding: Cryoneurolysis Instructions (A59752)

Use this page to view details for the Local Coverage Article for Billing and Coding: Cryoneurolysis Instructions.

www.cms.gov

 

[callmeanesthesia]

Iovera came sniffing around my ASC. I guess they lowered their product price.

I found a CMS LCD for Noridian that specifically said they should be using a T code and not the RFA codes. Does anyone know how much that T code reimburses?


CPT Codes:
• 0440T (upper extremity lovera)
• 0441T (lower extremity lovera)
• C9809 (cyroablation needle) - reimbursement is payor-dependent

Article - Billing and Coding: Cryoneurolysis Instructions (A59752)

Use this page to view details for the Local Coverage Article for Billing and Coding: Cryoneurolysis Instructions.

www.cms.gov

Procedure Price Lookup for Outpatient Services | Medicare.gov

Use official Procedure Price Lookup tool to compare national average to Medicare costs in ambulatory surgical centers, hosptial outpatient departments

www.medicare.gov

About $1450. It says the physician reimbursement is $0 though. I’m assuming that means the doctor bills a different code and the ASC bills the T code?

 

[Orin]

I think they just got sold/bought or something

Zimmer Biomet to pay up to $140M for Iovera nerve therapy tech from Pacira BioSciences

Pacira BioSciences announced today that it agreed to divest its Iovera nerve therapy device to Zimmer Biomet.

www.massdevice.com