cryoneurolysis genicular- payment?

[bedrock]

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Hi guys,

A local ortho group that will be sending me SCS trials has asked me about doing genicular cryo preop on their patients getting TKA. I have a few questions for the group here.

1- Anyone doing this?
2- How much do you get paid?
3-Do you have to do diagnostic blocks or you just do the cryo the day of surgery? Any preauth issues on medicare patients?
4- What cryo protocol do you use?

Willing to help this group particularly as they plan to send me quite a few SCS, but I want to make sure I won't get totally screwed here. Obviously just going to the hospital will cost me time and money.

 

[buddababa]

prior to the surgeon leaving his practice, i would do it average 2 weeks before surgery, back then insurance wasn't an issue. No need to do diagnostic blocks; however now insurance getting more difficult to get approval unless pure medicare. Also since cryo kit costs went up and reimbursement went down, i stopped using cryo

 

[cowboydoc]

Hi guys,

A local ortho group that will be sending me SCS trials has asked me about doing genicular cryo preop on their patients getting TKA. I have a few questions for the group here.

1- Anyone doing this?
2- How much do you get paid?
3-Do you have to do diagnostic blocks or you just do the cryo the day of surgery? Any preauth issues on medicare patients?
4- What cryo protocol do you use?

Willing to help this group particularly as they plan to send me quite a few SCS, but I want to make sure I won't get totally screwed here. Obviously just going to the hospital will cost me time and money.

I use iovera. 2 weeks preop, bill for “destruction of nerve” 64640 x3 and “u/s guidance for needle placement” 76942.

It takes me 20-30 min to do a knee.
No dx block. Easy if ok with u/s. Not a money maker.

 

[buddababa]

I use iovera. 2 weeks preop, bill for “destruction of nerve” 64640 x3 and “u/s guidance for needle placement” 76942.

It takes me 20-30 min to do a knee.
No dx block. Easy if ok with u/s. Not a money maker.

Are you still billing 64640 even though there's a new code out specifically for genicular nerves?

 

[smarterchild]

Some insurance companies are denying the genicular codes so I’ve had to use the 64640 code with certain payors

 

[buddababa]

Some insurance companies are denying the genicular codes so I’ve had to use the 64640 code with certain payors

understandable, but wouldn’t that constitute as fraud and risk of audit since the correct codes are not being used?

 

[bedrock]

prior to the surgeon leaving his practice, i would do it average 2 weeks before surgery, back then insurance wasn't an issue. No need to do diagnostic blocks; however now insurance getting more difficult to get approval unless pure medicare. Also since cryo kit costs went up and reimbursement went down, i stopped using cryo

in what setting were you doing this? ASC? Office ? HOPD? (Regarding the cost)

I use iovera. 2 weeks preop, bill for “destruction of nerve” 64640 x3 and “u/s guidance for needle placement” 76942.
It takes me 20-30 min to do a knee.
No dx block. Easy if ok with u/s. Not a money maker.

with iovera, do you need to be right on top of the nerve? Will I accomplish anything by using an iovera probe with fluoro or is it not useful without US?

any reason not to just do a thermal RFA Right before a TKA if you‘re just going to bill only 64640 x 3 anyway?

BTW, do the new Medicare genicular RFA codes require a diagnostic block? I’m wondering if I can just go straight to genicular RFA (and new code) for these patients

 

[cowboydoc]

Are you still billing 64640 even though there's a new code out specifically for genicular nerves?

I am. I’m targeting the AFCN, ISN and occasionally a genicular branch, not the 3 genicular branches targeted with RF. I’m not positive this is the correct billing since the new bundled code was added.

 

[cowboydoc]

in what setting were you doing this? ASC? Office ? HOPD? (Regarding the cost)


with iovera, do you need to be right on top of the nerve? Will I accomplish anything by using an iovera probe with fluoro or is it not useful without US?

any reason not to just do a thermal RFA Right before a TKA if you‘re just going to bill only 64640 x 3 anyway?

BTW, do the new Medicare genicular RFA codes require a diagnostic block? I’m wondering if I can just go straight to genicular RFA (and new code) for these patients

I’m doing iovera in office with u/s. It’s far cheaper and more efficient than fluoro (x2 with dx block), as my fluoro is in asc.

Good question about whether dx block is now required. I’ve had a few RFs denied by bcbs, iovera was ok.

You could probably use iovera with fluoro, but it would be hard to keep your hands clear, as the probe is heavy, and you couldn’t let go to take an image.

 

[deleted875186]

in what setting were you doing this? ASC? Office ? HOPD? (Regarding the cost)


with iovera, do you need to be right on top of the nerve? Will I accomplish anything by using an iovera probe with fluoro or is it not useful without US?

any reason not to just do a thermal RFA Right before a TKA if you‘re just going to bill only 64640 x 3 anyway?

BTW, do the new Medicare genicular RFA codes require a diagnostic block? I’m wondering if I can just go straight to genicular RFA (and new code) for these patients

Not good to do thermal RFA before surgery and cause necrosis in the area of surgery.

 

[bedrock]

Not good to do thermal RFA before surgery and cause necrosis in the area of surgery.

Makes sense. Thanks

I’m doing iovera in office with u/s. It’s far cheaper and more efficient than fluoro (x2 with dx block), as my fluoro is in asc.
Good question about whether dx block is now required. I’ve had a few RFs denied by bcbs, iovera was ok.
You could probably use iovera with fluoro, but it would be hard to keep your hands clear, as the probe is heavy, and you couldn’t let go to take an image.

Thank you, that is very helpful. Looks like iovera in office with US is the only way to go. I hope the machine isn't too expensive.

 

[callmeanesthesia]

Makes sense. Thanks

Thank you, that is very helpful. Looks like iovera in office with US is the only way to go. I hope the machine isn't too expensive.

It is. And so are the cartridges for it. If you are private practice it probably won’t pencil out. When I looked into it 2 years ago the company told me “if you have a good payor mix you won’t lose money on it.”

 

[NJPAIN]

It is. And so are the cartridges for it. If you are private practice it probably won’t pencil out. When I looked into it 2 years ago the company told me “if you have a good payor mix you won’t lose money on it.”

These companies live on PIP and WC. You have to be so careful that you don’t loose money. Even having the distributor lend me their unit and only paying for the cartridge I did not break even.

The fee schedules have no relationship to the cost of supplies. I had a managed Medicare patient for visco. Tried to approve Hymovis. Denied and told need to use preferred product- Durolane. Purchased Durolane for $850. A truckload would have brought price to $750. Insurance paid $500.

 

[Ligament]

Cash pay. I have an epimed painblocker unit.