Dx MBB again?

[epidural man]

probably asked before....

A new patient presents asking for RFA. He says he got excellent relief from previous RFA (bilateral).

Your pretest probability (based on all your info) is that he is likely to have facet mediated pain but you don't have images from previous procedures.

Do you proceed with RFA - or would you want to do a diagnostic medial branch block first?

Do you do bilateral again? How many of you like to only do unilateral at a time?

If you said you would like to repeat the Dx MBB, would it make a difference if you were the one that did the RFA, and he got 9 months of excellent relief, and you are now seeing him again 2 years latter with what he says is the same pain. Would you want to see the Dx MBB results again? Or proceed with the RFA?

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[Pacman27]

Cohen, wrote a nice article in regards to the utility and cost regarding the medial branch blocks. I know he advocated one or none.

Personally, I would do at least one set of B/L MBB's and then proceed with RFA. Prob do one side at a time.

Of course this is is very patient dept. If I had someone on blood thinners, then I would do the MBB's with the blood thinners and then consider stopping the blood thinners and do the B/L RFA (stopping the blood thinners, only because its a larger gauge needle).

I attached the article to this email.

 

[SSdoc33]

if i did RFA in past, i'd redo the bilateral RFA.

if it wasnt me, id do a MBB first, then RFA. always bilateral if they have bilateral pain. i am eating the cost of the -50 modifier, i realize

 

[PinchandBurn]

probably asked before....

A new patient presents asking for RFA. He says he got excellent relief from previous RFA (bilateral).

Your pretest probability (based on all your info) is that he is likely to have facet mediated pain but you don't have images from previous procedures.

Do you proceed with RFA - or would you want to do a diagnostic medial branch block first?

Do you do bilateral again? How many of you like to only do unilateral at a time?

If you said you would like to repeat the Dx MBB, would it make a difference if you were the one that did the RFA, and he got 9 months of excellent relief, and you are now seeing him again 2 years latter with what he says is the same pain. Would you want to see the Dx MBB results again? Or proceed with the RFA?

depends ...

if it's a trustworthy patient. I would ask for the old MD's OP note. Document what levels were done. If c/w with my PhysicaL Exam. Then I would just do the RFA. Whts the point in redoing mbbs.

 

[Ducttape]

may also want to check with patient's insurance. there are a couple that require MBB recently or will not authorize RFA again.

 

[emd123]

may also want to check with patient's insurance. there are a couple that require MBB recently or will not authorize RFA again.

This is the biggest thing, to make sure you don't eat the cost of an RF procedure. Like anything else nowadays, the tail wags the dog and we look to the insurance companies as how to treat our patients first. It's the way it is though, and has been for a long time now, and will only get worse with 2000 pages of Obamacare to follow. Such is life.

 

[pmrmd]

You have to repeat some blocks to see if the same level(s) are the pain generators.

 

[clubdeac]

Does medicare/medicaid or certain private insurers only pay for a certain number of facet injections within a certain time frame?

 

[PinchandBurn]

what's the big deal?

That's what I implied. Get the old MDs records. Then get a PRior Auth from the insurance company saying Patinet X had a RFA done by Dr. X, it provided Y months/years of relief. I am going to do the same thing for the patient,etc.....I would in any way always get a PA.

 

[Ducttape]

Does medicare/medicaid or certain private insurers only pay for a certain number of facet injections within a certain time frame?

yes.

in my area, medicare allows only 2 RFAs for a specific joint per year, or once every 6 months, for example.

also, managed medicaid companies do not allow intra-articular steroids into facet joints, so "facet joint injections" are out.


i have had denial for PA for exactly what you requested, Pinch. to the best of my recollection. their specific contention was that it was not within 2 year period, and i was not "the physician who performed the performed the previous successful procedure".