How long after surgery before SCS trial?

[pain101]

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Say you have a patient who had L5/S1 PLIF 6 months ago, continues to have significant radicular pain and wants to pursue SCS. Would you wait longer before calling this FBSS and proceeding with SCS trial?

 

[Agast]

I do a caudal ESI before I commit to a stim trial. SI joint injections if exam is appropriate. That pushes the stim trial closer to 8-9 months post op where you will have a better idea of how permanent the radiculitis is.

 

[SpineandWine]

I'd get MRI look for stenosis elsewhere and consider TFESI +/- SI joint
Double check - ensure surgical team has gotten CT scan and r/o hardware failure, lucency around hardware, c/f infection, screw malposition, etc.

 

[Status Sciaticus]

we do 1 year from surgery to look for both union/mal-union/non-union and signs of true surgical failure.

EDIT:
Rather than use FBSS, you can use post surgical spinal pain and chronic lumbar radiculopathy as the indications.

 

[Ronin1]

Go ahead with a trial. Most likely has a nerve injury no matter what happens with the fusion.

 

[gaseous_clay]

we do 1 year from surgery to look for both union/mal-union/non-union and signs of true surgical failure.

EDIT:
Rather than use FBSS, you can use post surgical spinal pain and chronic lumbar radiculopathy as the indications.

How are you getting this authorized through insurance without chronic pain syndrome as the primary diagnosis?

 

[Agast]

How are you getting this authorized through insurance without chronic pain syndrome as the primary diagnosis?

I was told chronic pain syndrome is the secondary diagnosis, you cannot bill it as the primary diagnosis. At least for private insurance.

ICD 10 code list for SCS coverage at the bottom here. Please note that even though lumbar radiculitis is a supported code, the patient is still required to have failed surgery. Some people are using this code in virgin spines.

MCD Search

The Redesigned MCD Search Page lets you search on a keyword, code, or document ID

www.cms.gov

 

[gaseous_clay]

I was told chronic pain syndrome is the secondary diagnosis, you cannot bill it as the primary diagnosis. At least for private insurance.

ICD 10 code list for SCS coverage at the bottom here. Please note that even though lumbar radiculitis is a supported code, the patient is still required to have failed surgery. Some people are using this code in virgin spines.

MCD Search

The Redesigned MCD Search Page lets you search on a keyword, code, or document ID

www.cms.gov

First Coast Service Option is the MAC for your geographical region (although I thought you were in Texas 🤔). If you look at the SCS LCDs for my MAC, it doesn’t outline any group 1 codes like yours does. The way you’re coding and billing for it is per your MAC’s requirements.

MCD Search

The Redesigned MCD Search Page lets you search on a keyword, code, or document ID

www.cms.gov

 

[Status Sciaticus]

How are you getting this authorized through insurance without chronic pain syndrome as the primary diagnosis?

All my chronic pain patients have chronic pain syndrome since theyre all in chronic pain.

I was told chronic pain syndrome is the secondary diagnosis, you cannot bill it as the primary diagnosis. At least for private insurance.

ICD 10 code list for SCS coverage at the bottom here. Please note that even though lumbar radiculitis is a supported code, the patient is still required to have failed surgery. Some people are using this code in virgin spines.

MCD Search

The Redesigned MCD Search Page lets you search on a keyword, code, or document ID

www.cms.gov

I dont believe this is correct. You just need a surgeon to say there is no target to intervene on, even if pathology (disc bulge, compression, etc,,,) is present.

We've put in plenty of stims in patients who fail epidurals with very good results.

 

[Dr. Ice]

Chronic radiculopathy in patients who are not surgical candidates and who have failed conservative management qualify for scs in my neck of the woods..

Agast, I’m in New Jersey, I can assure you wherever you are, I’m dealing with a nightmarish hell that you can’t even imagine and I can still get coverage

 

[clubdeac]

Anyone hear anything about SCS cuts coming? There was some talk in my group about this. Not sure if it was legit or just rumor

 

[CleanUp]

Anyone hear anything about SCS cuts coming? There was some talk in my group about this. Not sure if it was legit or just rumor

rumor has it there’s a shadow ban (or increased risk of claw back) on people who have less than stellar trial to implant ratios.