Final Countdown for CPT 27278...

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drusso

drusso

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I had them stop by and they are in no way shape or form ready for Jan 1 2024 implants in office.
 
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I’m not ready

They are going to have a start up checklist soon

Training offered next year

If already implanting could do day one if procedure suite next room to asc or something
 
I’m sure I’ll catch heat for this but my n=4 are successes for this. I’m very selective and really focus on buttock pain, sitting tolerance and pain during sitting to standing.

Maybe my SIJ RFA technique was suboptimal but I didn’t get as high of success rate for RFA.

I have no intention to do these in office just for the record.
 
CleanUp said:
I’m sure I’ll catch heat for this but my n=4 are successes for this. I’m very selective and really focus on buttock pain, sitting tolerance and pain during sitting to standing.

Maybe my SIJ RFA technique was suboptimal but I didn’t get as high of success rate for RFA.

I have no intention to do these in office just for the record.
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There have been many previous threads proving that this procedure does not actually help patients 😇
 
I have been using SI Bone and have found the results to be fantastic. 27279. If you have ownership in ASC great for you, if not the prof fee is meh but on the right patient 👍👍👍
 
It's interesting to me how much hype SI fusions get. As ASC owner, the margins are good but not great, per unit time it's equal to / moderately better than bread and butter in my neck of the woods/contracts.
 
RoloTomassi said:
It's interesting to me how much hype SI fusions get. As ASC owner, the margins are good but not great, per unit time it's equal to / moderately better than bread and butter in my neck of the woods/contracts.
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Equivalent to around 15 bread and butter procedures after taking cost of implant. Procedure time for SI fusion is no more than 45 minutes.
 
blokdoc said:
Equivalent to around 15 bread and butter procedures after taking cost of implant. Procedure time for SI fusion is no more than 45 minutes.
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Equivalent to 2-3 RFA with my contracts, 30-45 min
 
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You guys doing this procedure, are you educating your patients on the natural distribution of load among joints in the body and how fusing joints creates a permanent, unnatural load distribution?

This is a conversation I have with every patient considering any kind of fusion.
 
So if I decide to finally start doing these, which product available to pain management has the best outcomes?
 
I really liked Vyrsa Pro for a 27278 approach. I have used Omnia and Cornerloc and thought Vyrsa was the best of the three. Omnia and PainTec are pretty much the same thing.
 
BobBarker said:
I really liked Vyrsa Pro for a 27278 approach. I have used Omnia and Cornerloc and thought Vyrsa was the best of the three. Omnia and PainTec are pretty much the same thing.
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Which one has the most appropriate use of the actual CPT code? I’m a little uncomfortable with creative interpretation of what constitutes an SI joint fusion
 
Can’t be creative at this point. 27278 if you use bone graft, 27279 if you use screws or a titanium si implant. There are several of all of those options.
 
Can anyone share with me how SIJ fusions actually help the patient? Not trying to fight, just don’t actually get how fusing a stable joint works. The reps are whoring themselves out big time on these. They also can’t answer the question, but just say well what else is there to do for these people.

Saved someone recently from getting it with PRP. Did bilateral SIJ prp last August and he has no pain. He actually was scheduled for fusion with a kol a week after he saw me and decided to cancel and take a chance on prp.
 
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Dr. Ice said:
Can anyone share with me how SIJ fusions actually help the patient? Not trying to fight, just don’t actually get how fusing a stable joint works. The reps are whoring themselves out big time on these. They also can’t answer the question, but just say well what else is there to do for these people.

Saved someone recently from getting it with PRP. Did bilateral SIJ prp last August and he has no pain. He actually was scheduled for fusion with a kol a week after he saw me and decided to cancel and take a chance on prp.
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Would love to hear as well.

I'm open to learning the procedure if someone can explain how or why it works.

PRP, or I'll RFA L5-S1 + S1 LB. I bill for one level RFA and do the S1 LB for free.
 
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Dr. Ice said:
Can anyone share with me how SIJ fusions actually help the patient? Not trying to fight, just don’t actually get how fusing a stable joint works. The reps are whoring themselves out big time on these. They also can’t answer the question, but just say well what else is there to do for these people.

Saved someone recently from getting it with PRP. Did bilateral SIJ prp last August and he has no pain. He actually was scheduled for fusion with a kol a week after he saw me and decided to cancel and take a chance on prp.
Click to expand...

Some KOL's are combining fusion and PRP for optimized outcomes.
 
I don't see a whole lot of SIJ pain period. It's always in my differential so I'm not under diagnosing. But by the time I work through the spinal pathology algorithm it rarely seems to be SIJ, certainly not the 15% number people reference. Last few I saw were specific populations--fused to S1, rheumatologic, postpartum.
 
Dr. Ice said:
Can anyone share with me how SIJ fusions actually help the patient? Not trying to fight, just don’t actually get how fusing a stable joint works. The reps are whoring themselves out big time on these. They also can’t answer the question, but just say well what else is there to do for these people.

Saved someone recently from getting it with PRP. Did bilateral SIJ prp last August and he has no pain. He actually was scheduled for fusion with a kol a week after he saw me and decided to cancel and take a chance on prp.
Click to expand...


What is the technique? Do you do the PRP right into the joint or just the ligaments around the joint, or both?
 
RoloTomassi said:
I don't see a whole lot of SIJ pain period. It's always in my differential so I'm not under diagnosing. But by the time I work through the spinal pathology algorithm it rarely seems to be SIJ, certainly not the 15% number people reference. Last few I saw were specific populations--fused to S1, rheumatologic, postpartum.
Click to expand...
Not to argumentative my brother in pain but what is it when someone is fused, diffuse OA, has buttock pain, and worse with sitting?
 
CleanUp said:
Not to argumentative my brother in pain but what is it when someone is fused, diffuse OA, has buttock pain, and worse with sitting?
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Buttock location and worse with sitting are not very specific. Can certainly be SIJ but often adjacent segment above and/or below (discogenic, facetogenic, vertebrogenic, stenosis). Then there's all the hip/gluteal stuff too.
 
callmeanesthesia said:
Are you guys doing PRP for patients with lumbosacral fusion? I would think that would be a very temporary fix with the biomechanical stressors.
Click to expand...

I suggest SIJ RFA over PRP for patient s/p L5-S1 fusion and PRP over SIJ RFA for patients without L5-S1 fusion.

But I’d still give the patient both options.
 
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