Genicular Art Embolization

[PinchandBurn]

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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....

 

[Agast]

https://www.bostonscientific.com/content/dam/bostonscientific/Reimbursement/peripheral-intervention/pdf/embolization_coding_guide.pdf

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.

 

[PinchandBurn]

https://www.bostonscientific.com/content/dam/bostonscientific/Reimbursement/peripheral-intervention/pdf/embolization_coding_guide.pdf

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.

 

[Ducttape]

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.

 

[Agast]

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.

 

[bedrock]

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.

 

[PinchandBurn]

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

 

[PinchandBurn]

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..

 

[Malayil]

How much is the kit etc

 

[painfree23]

You do this in clinic??

 

[Agast]

I’m curious why the pain radiology KOLs aren’t fawning all over this. Wouldn’t this be right up their alley.

 

[BobBarker]

A lot of them haven’t done anything vascular in a very long time. I asked my local one about it.

 

[PinchandBurn]

How much is the kit etc

2k

 

[Taus]

2k

And pro fee? Global fee in office? Lots of interest in this by my ortho colleagues.

 

[BobBarker]

@Taus
You guys going to hire IR prn to come in and do this?

 

[Taus]

@Taus
You guys going to hire IR prn to come in and do this?

Exploring it. No intention of doing it myself

 

[BobBarker]

I think interventional cards should be able to
do it, vasc surgery, neuro IR, etc

 

[RoloTomassi]

Not the best margin for a 2 h procedure

 

[cowboydoc]

I think interventional cards should be able to
do it, vasc surgery, neuro IR, etc

I talked with Doug Beall. He hadn’t stuck anyone in the groin since fellowship

Poor guy needs to get out and socialize more.

 

[Taus]

Not the best margin for a 2 h procedure

#’s?

 

[RoloTomassi]

#’s?

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.

 

[interjectionreflection]

Bridging the Gap between Injections and Surgery: Meta-Analysis of Genicular Artery Embolization in Knee Osteoarthritis - ScienceDirect https://share.google/xS5KobtAmurVUA39H


Haven't had chance to read full thing yet but seems to suggest the results are overhyped

 

[PinchandBurn]

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.

GENICULAR ARTERY EMBOLIZATION - REIMBURSEMENT CHALLENGES - StreamlineMD

Challenges with GAE reimbursement vary across carriers

streamlinemd.com

 

[Ducttape]

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.

 

[SpineandWine]

I feel this is occurring all across the country. Can they claw back everything?
Everyone is doing it
Can’t find specific LCDs

 

[SpineandWine]

Exploring it. No intention of doing it myself

So the IR docs doing it are likely using hemearthrosis as diagnosis (like way pain docs use genicular nerve neuralgia for knee pain). So that’s how it’s booming/expanding recently

BTW- collaterals could form so not sure if it’s permanent relief

 

[PinchandBurn]

So the IR docs doing it are likely using hemearthrosis as diagnosis (like way pain docs use genicular nerve neuralgia for knee pain). So that’s how it’s booming/expanding recently

BTW- collaterals could form so not sure if it’s permanent relief

It's probably not perfect. But what is including Knee replacement (failure rate for that is 5-15%). From what I can tell and from talking to people that have seen it done and have had patients get it done, is a small rash to the surface of the knee occur. This is presumably d/t lack of blood floor but is treated conservatively and the patient goes home. Also, instead of accessing the artery from the groin and going down, many are doing it at the pedal level and going up. Supposedly easier approach and you dont have to worry about femoral hematomas...

I think if I had knee problems the algorithm for tx would be
knee steroid injections
PRP
GAE vs Genicular Nerve Ablation (not sure which is better, but about the same invasiveness)
Knee Replacement.