genicular nerve RF

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Taus said:
See you there!

Anyone doing cooled rf in private office setting and having success getting the kits covered and the whole thing not be a money loser?
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No one does cooled RF in private practice, unless they work at a hospital, and most hospitals are wising up to the obscene cost of the cooled RF probes, and pulling the plug.

When u start in private practice, u have to learn to refer a certain percentage of your patients to academic centers where cost doesn't matter as much
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bedrock said:
No one does cooled RF in private practice, unless they work at a hospital, and most hospitals are wising up to the obscene cost of the cooled RF probes, and pulling the plug.

When u start in private practice, u have to learn to refer a certain percentage of your patients to academic centers where cost doesn't matter as much
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Concur. I cannot fathom how people could absorb the cost of cooled RF in private practice unless it is cash pay.
 
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Taus said:
Well then... anyone doing hip or knee w conventional RF?
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cooled RF not required for either procedure. Successful RF with standard RF probes has been described in the literature.
Steve has done a number of knee cases with standard RF probes, from what he's posted.
 
b
Taus said:
See you there!

Anyone doing cooled rf in private office setting and having success getting the kits covered and the whole thing not be a money loser?
Click to expand...
do you have the flyer or contact info for the course?
 
lobelsteve said:
Every day.
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We are trying to figure out the best step for lesioning the genicular nerves.
We have a steady stream of referrals for the diagnostic blocks and majority of patients are getting good relief

We are not using Cooled RF and have 20g RF cannula of varying lengths.

I was planning on using 60mm needles/probes which have a 10mm active tip.
Since you are using conventional RF would you recommend a single or multiple lesions?
If multiple, how are you doing this? just rotating needle or withdrawing and moving cephalad/caudad

One thought the other doc and I had was placing 2 needles and performing bipolar lesion b/wthe two needles to increase lesion size, thoughts?
 
how are you coding for RF of the hip? 27035? It wasn't quite clear from the discussion above. Thanks
 
Reviving the thread... What are people coding for the diagnostic block? The Choi article describes using 2% lidocaine for the block. Does anybody use anything different for the diagnostic? Have my first few patients for this technique coming up.
 
drrosenrosen said:
Reviving the thread... What are people coding for the diagnostic block? The Choi article describes using 2% lidocaine for the block. Does anybody use anything different for the diagnostic? Have my first few patients for this technique coming up.
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64450 x2 77002 x1 for block. 2% lido or 0.25% bupi.
 
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Steve why not x 3 on block code? Superior medial and lat and inferior medial is 3 nerves?

I'm using 0.5 % Bup fwiw after skin local
 
specepic said:
Steve why not x 3 on block code? Superior medial and lat and inferior medial is 3 nerves?

I'm using 0.5 % Bup fwiw after skin local
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My revenue integrity people in charge of coding compliance for our hospital system said that the 2 medial nerves are part of femoral and the lateral is part of sciatic. So they only let me bill 2 nerves.
 
hmm, strange. IMO, that is incorrect, in the end they all come from the brain, or the cord, or whatever. seems like a strange deliniation. do they have a citation for why that is appropriate? clearly it is 3 seperate sites.

I think the logical litmus test is: does burning one of the two sites have the same effect as burning both? in this case, no. Opposed to burning the sciatic nerve and burning the fibular nerve. (not that you would do that). burning the fibular nerve is moot in that case.

I that they are extrapolating from regional anesthesia guidelines which probably prohibit billing of let's say a fibular nerve block if you already block the sciatic, because of redundancy. In this case, there is no redundancy and they are incorrect I think. Don't let thei overabundance of caution steal from your productivity credit. Unless you are wiser than me and have learned that arguing with hospital administration is usually fruitless :)

There is now a fourth site to lesion ("capsular" site?) but I havent looked into that and am not doing it as of now
 
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lobelsteve said:
My revenue integrity people in charge of coding compliance for our hospital system said that the 2 medial nerves are part of femoral and the lateral is part of sciatic. So they only let me bill 2 nerves.
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By this logic you could bill sciatic and femoral nerve blocks instead of unspecified which I think is fine as well and would pay a bit better I think compared to 64450 X2 .
 
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I don't get it. Baylis has spent millions on this "Coolief" cooled RF marketing campaign, and the only place any doc can do the procedure is in the hospital given the $800 probe cost.

Can somebody explain to me how this can be done in private practice???
 
Ligament said:
I don't get it. Baylis has spent millions on this "Coolief" cooled RF marketing campaign, and the only place any doc can do the procedure is in the hospital given the $800 probe cost.

Can somebody explain to me how this can be done in private practice???
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I'd like the answer as well.
I have only been able to do in hospital and only after much hassle. I have been told that some States such as NY have loop holes that allow certain ASCs to get reimbursed for the kit because they are considered like hospitals for reimbursement purposes. There is a doc in a neighboring area of NYS who does ONLY water-cooed RF. The KC rep tells me it is because of the "loop hole".
 
steve documented somewhere that he is actually targetting branches of 2 nerves.
Ligament said:
I don't get it. Baylis has spent millions on this "Coolief" cooled RF marketing campaign, and the only place any doc can do the procedure is in the hospital given the $800 probe cost.

Can somebody explain to me how this can be done in private practice???
Click to expand...
maybe there is a reason to be a hospital employed physician?


nah!
 
nvrsumr said:
By this logic you could bill sciatic and femoral nerve blocks instead of unspecified which I think is fine as well and would pay a bit better I think compared to 64450 X2 .
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I like this idea. Will submit cpt for these blocks and hopefully get upgraded and clarified.
 
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Anybody got any pictures of femoral and obterator blocks. I have one scheduled and am seeing different locations for the obterator placement online
 
never done one.....am being sent patients from the VA asking specifically for this. It seems appropriate for the patient's with bilateral TKR's. Guess ill have to learn.
 
spondy14 said:
Anyone start doing cooled RF in the office yet? How about ASC?
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Refer to the comment I made on the top of this page.

Cooled RF is too expensive for pp, whether the procedure is done in office or at an ASC.

The only feasible option now (other than sending pt to university hospital that offers this) is to require that the patient buys the probe.
 
Anyone have data that cooled RFA works better than thermal for genicular? Cooled should be easier to do but cost is prohibitive.
 
pastafan said:
Anyone have data that cooled RFA works better than thermal for genicular? Cooled should be easier to do but cost is prohibitive.
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There are few studies on genicular RF period, let alone cooled RF.

Besides cooled RF probes are completely unnecessary for genicular RF. If your patients aren't improving after genicular RF with regular RF needles, then they weren't good candidates for it to begin with or your technique is wrong.

BTW, if you want to be extra certain you're creating a large lesion, you can easily buy 16G regular RF cannulae for the same prices as 20G or 18G. I use 16G for genicular RF, but the procedure works just fine with regular 18G RF cannulae
 
I use the ribbed cannulae with receptacle tips. Extra large.
 
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Anyone know or have specific angles for the femoral branch RFA? Little to know exposure to this injection in fellowship. Lots of end stage hip referrals who don’t want or not candidates for injections. Also with obturator branch, can go coaxial with 70 degree ipsilateral oblique and 20 degree cephalad correct? With Stryker Venom, do you use 18g or 20g? Thank you!
 
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Bsb2015 said:
Anyone know or have specific angles for the femoral branch RFA? Little to know exposure to this injection in fellowship. Lots of end stage hip referrals who don’t want or not candidates for injections. Also with obturator branch, can go coaxial with 70 degree ipsilateral oblique and 20 degree cephalad correct? With Stryker Venom, do you use 18g or 20g? Thank you!
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Make your image look like Simopoulis's images.
 
I've got a newsflash for you guys; it is HIGHLY unlikely we are near the genicular nerves when doing RF using the fluoroscopic approach. I know this as I also do my genicular nerve blocks under ultrasound, and can directly visualize the nerves.

That said, it DOES work when done under fluoro, even though I'm certain we are not near the nerve 50% of the time. Suspect pain relief is from frying the joint capsule or from a PRP like effect from the hemearthrosis we are causing but popping through the capsule with thick RF needles. I had one guy with a very significant hemearthrosis using 16ga RF cannulae.
 
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IMG_1501.jpg
IMG_1503.jpg
IMG_1502.jpg


Someone tell me what I did wrong. I’m not sure if this helped the poor guy.
 
Ligament said:
This looks like VERY nice needle placement.

Remember these nerves are not in an anatomically consistent location such as with the medial branches...so can miss them even with great anatomic placement.
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I was thinking his obturator placement was a little too lateral. I place them closer to the tear drop seen on the pelvis
 
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swamprat said:
I was thinking his obturator placement was a little too lateral. I place them closer to the tear drop seen on the pelvis
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Likewise, my femoral target is slightly superior to this placement, but I like these pics. In both cases, placement is on the expected nerve path (as best we can tell.) I adapted the placement from coolief "research." (I've posted their slides before)

Pmrmd, You didn't do anything wrong. That's a $#!+ Hip. Looks like you gave the patient a fair chance at benefit with the dull tool we are welding in 2019.
 
Up date: the guy with that hip RF is about 50% better. He thought the cracking sound was supposed to resolve too. Thanks for your input cowboy and swamprat
 
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pmrmd said:
Up date: the guy with that hip RF is about 50% better. He thought the cracking sound was supposed to resolve too. Thanks for your input cowboy and swamprat
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May I ask? Why are you insert two cannulas?
 
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