Dealing with insurance dictating procedures..

[Laryngospasm]

Hey everyone, I can’t be the only one dealing with facet treatment denials when the patients notes some leg pain. I literally had a denial where the patient had severe facet OA, mild foraminal stenosis and more back pain than leg pain with pos. Facet loading etc. The denial said “your imaging shows other causes” so now we have someone probably with no training in pain and probably not even a doctor dealing out denials based on imaging reports. This seems to be more and more common. Any thoughts?

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[Agast]

How are you documenting the leg pain in your note? I’m always careful to avoid key words like “radiating” to make it past the clipboard police

 

[Laryngospasm]

I try to avoid that.. but sometimes they will tell the nurse they have some leg pain and they document on intake. I’m unclear on how and when insurance became able to dictate what we do and treat first. I treat whatever I feel the root cause of the patients most limiting pain is.

 

[cowboydoc]

"referral into thigh" never "radiating" if I want to do a facet intervention.

You need to keep notes clean, OTOH, sometimes there is no winning no matter what you do. An insurance doc I deal with frequently is terrible. "I won't approve a MBB, but you can do an SIJ." WTF, I'm not doing a procedure that isn't medically indicated to appease your corporate algorithm.

 

[MitchLevi]

Back, buttock and proximal leg pain is what I document daily.

 

[Crybaby]

Medicare or all in general
For Medicare, I have started putting the name of who ever denies the medicare claim in my note upon follow up. if it helps tbd..... but I want those who deny to know I am watching

 

[Ronin1]

My notes for people on the MB/RFA track are very streamlined. No mention of other options. No discussion of anything else. Just the template/ MRI/Physical Exam all demonstrating facet mediated pain. And still get some kickback….

 

[MitchLevi]

Medicare or all in general
For Medicare, I have started putting the name of who ever denies the medicare claim in my note upon follow up. if it helps tbd..... but I want those who deny to know I am watching

They can deny telling you their name. It's happened to me. Outright refusal to give their name.

 

[SSdoc33]

Why are you wasting your time on a P2P? Just read the denial, change your note, and resubmit

 

[bedrock]

Some docs just lie, but for the greater good.

All MBB/RFA candidates have zero extremity pain, wink wink.
All ESI candidates have a perfectly matching mild neurologic deficit that fits their level of pathology, etc.

If bureaucrats interfere with the practice of good medicine then maybe medicine needs to interfere with bureaucracy….

 

[RoloTomassi]

Some docs just lie, but for the greater good.

All MBB/RFA candidates have zero extremity pain wink wink.
All ESI candidates have a perfectly matching mild neurologic deficit that fits their level of pathology, etc.

If bureaucrats interfere with the practice of good medicine then maybe medicine needs to interfere with bureaucracy….

My sentiments exactly. If they're going to make BS rules, they're going to get some BS notes

 

[Drd105]

My sentiments exactly. If they're going to make BS rules, they're going to get some BS notes

🤣

 

[Doctodd]

clearly write/type/dictate "non-radicular"