Ganglion Impar

[Ducttape]

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i would suggest that if you are doing this more than once or twice a month without a valid reason (holding anticoagulation, long travel for patient) - then it may be considered routine.

Medicare again retroactively looks at this, not prospectively, so you will never have issues, until an audit for improper payment. you will always get paid.


caveat emptor.


if you get audited, good luck. hopefully you never do.


i for one am extraordinarily risk averse, so i do my best to follow the guidelines so i do not have concerns about future audits. you may rail against bureaucrats, but they hold the money and power.

 

[clubdeac]

i would suggest that if you are doing this more than once or twice a month without a valid reason (holding anticoagulation, long travel for patient) - then it may be considered routine.

Medicare again retroactively looks at this, not prospectively, so you will never have issues, until an audit for improper payment. you will always get paid.


caveat emptor.


if you get audited, good luck. hopefully you never do.


i for one am extraordinarily risk averse, so i do my best to follow the guidelines so i do not have concerns about future audits. you may rail against bureaucrats, but they hold the money and power.

But you also don’t do injections or prescribe medications 😜

 

[SC Tian]

It is not routinely necessary for multiple blocks (e.g., epidural injections, sympathetic blocks, trigger point injections, etc.) to be provided to a patient on the same day as facet joint procedures. Multiple blocks on the same day could lead to improper or lack of diagnosis. If performed, the medical necessity of each injection (at the same or a different level)

If I do 6 medicare ESI with a troch bursa injection, out of 80 medicare injections that I do in a month, it is not a routine injection as I'm doing this on less than 10% of the medicare ESI each month.

Besides, most of these patients have had previous blind bursa injections with less than ideal relief, which i document, and so I then have justification to do ESI with bursa injection.

Medicare has never had a issue with me doing this over a dozen years in three states. Always been paid.

I don't spend my time worrying about stupid "guidelines" made by bureaucrats who don't know anything about my clinical field.

Thanks, IMO, LCDs for the epidural and facet injections discouraged multiple injections for the same pathologies, here when we do multiple injections during the same visit, we used modifier -59, for different procedures for different diagnoses of ICD-10 codes, this is not restricted, however, I don't by any means do those routinely.

 

[SSdoc33]

i would suggest that if you are doing this more than once or twice a month without a valid reason (holding anticoagulation, long travel for patient) - then it may be considered routine.

Medicare again retroactively looks at this, not prospectively, so you will never have issues, until an audit for improper payment. you will always get paid.


caveat emptor.


if you get audited, good luck. hopefully you never do.


i for one am extraordinarily risk averse, so i do my best to follow the guidelines so i do not have concerns about future audits. you may rail against bureaucrats, but they hold the money and power.

ducttape has never broken the speed limit

 

[TIVAndy]

oops, what's the CPT code for rectal puncture and poop biopsy under fluoro guidance?

 

[lobelsteve]

Case in Maryland 10 years ago was SIJ RF. Punctured and lesioned sigmoid. Screaming patient ignored. Went to ER and CT clearly shows what went wrong.

 

[SSdoc33]

there is a rectum not too far from the needle tip in a ganglion impar. definitely could happen there as well.

 

[Centurion38]

How do you get into the sigmoid colon doing an SIJ RFA?

 

[bedrock]

Case in Maryland 10 years ago was SIJ RF. Punctured and lesioned sigmoid. Screaming patient ignored. Went to ER and CT clearly shows what went wrong.

Can’t believe the screaming patient was ignored. ******* needs to be sued.

 

[lobelsteve]

Can’t believe the screaming patient was ignored. ******* needs to be sued.

How do you think I know about it....

 

[bedrock]

How do you think I know about it....

Figured as much

 

[Welcome123]

You can definitely do that. Generally one or both are not spine procedures,

Billing a joint injection and a nerve block 64450 on the same day is very doable.

Billing a LESI and a fluoro guided troch bursa injection are doable.

Billing a CESI and a lumbar RFA is not.

This is really carrier dependent
I would check first and if unsure a predeterminaction may be warranted