Genicular Art Embolization

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

PinchandBurn

Full Member
10+ Year Member
Joined
Jul 26, 2010
Messages
2,544
Reaction score
273
any of you familiar with this procedure?

IR guys are doing it. Apparently great results. I saw a booth at Beckers for this company called Embolix that does this.

Seems only paid for by Medicare. I have friends that have these guys do it at their clinics, apparently it's been working out well for them clinically. Almost no side effects. Possible rash that can happen after the procedure on the skin, but it resolves.

Thoughts? Any other side effects or things you all are seeing. I may have these guys come into my practice and do this....
 

IMG_5336.jpeg

They are using CPT code 37242 which is technically for embolization for aneurysms or vascular malformations if you follow the code to its full definition. Medicare does not have an LCD directing specific usage so you can apply it to the genicular nerves for those patients, but obviously not for Medicare Advantage. Still if it’s a permanent treatment, it may be worth cash pay for patients to do it.
 

View attachment 405818
They are using CPT code 37242 which is technically for embolization for aneurysms or vascular malformations if you follow the code to its full definition. Medicare does not have an LCD directing specific usage so you can apply it to the genicular nerves for those patients, but obviously not for Medicare Advantage. Still if it’s a permanent treatment, it may be worth cash pay for patients to do it.
so it can only be done for just 'red white and blue" mcr? not for advantage ?

they were upfront and stated it's hard and vary rarely covered for commercial plans.

seems benign and wont harm patients.
 
i think it might be important to remember that "approved by Medicare" may be a misnomer.

one can get "paid" by medicare for a procedure, but the money, unlike with other insurances, can be clawed back at a later date.
 
I don’t think there’s any problems with having your patients do it, I would avoid trying to obtain some monetary benefit from it yourself in the case of possible future clawbacks. At least with our genicular nerve blocks and ablations it specifies the genicular nerve so there’s no question of whether our codes are misapplied.
 
Every end stage knee patient possible, I send for genicular embolization. Permanent for patient, and I don’t need to do a temp only ablation which also pays poorly.
That's good to hear

Its cutting edge. Probably why no lcd yet
 
Every end stage knee patient possible, I send for genicular embolization. Permanent for patient, and I don’t need to do a temp only ablation which also pays poorly.
Is this being done at your center? Where r you getting it done.

Appears to be awesome. Wish there was an lcd..although maybe its good there isnt..
 
I’m curious why the pain radiology KOLs aren’t fawning all over this. Wouldn’t this be right up their alley.
 
I'm just going off your chart and Pinchandburn.

In office 6.5k - 2k kit = 4.5k before paying IR. Not terrible if you have a block of dead time in procedure room and line up cases.

Weird the chart doesn't have ASC fee only HOPD.
 
I'm just going off your chart and Pinchandburn.

In office 6.5k - 2k kit = 4.5k before paying IR. Not terrible if you have a block of dead time in procedure room and line up cases.

Weird the chart doesn't have ASC fee only HOPD.
My question is just bceause there's no LCD, why would money get clawed bacK?

the NCD for embolization is very vague.

 
in the absence of an LCD, Medicare will still only "provide for services that are deemed reasonable and necessary".



so in effect they reserve the right to review charts and then claw back any procedure that is not specifically outlined in an LCD and some reviewer does not deem reasonable and necessary.
 
Top