Intracept RVU

[bedrock]

Can someone HOPD please tell me how many wRVUs for a one level and two level Intracept procedure?

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[SSdoc33]

Can someone HOPD please tell me how many wRVUs for a one level and two level Intracept procedure?

ive been told it is equivalent to a kypho. i dont know that for sure

 

[stsa84]

Looks like 7.15 for one level (two vertebrae), 3.77 for additional level

https://www.relievant.com/wp-content/uploads/2022/04/2022-Reimbursement-Guide-1.pdf

 

[Tboned]

Looks like 7.15 for one level (two vertebrae), 3.77 for additional level

https://www.relievant.com/wp-content/uploads/2022/04/2022-Reimbursement-Guide-1.pdf

Agree. I get the wRVU work pellets and the 7.15 and 3.77 is what I have been receiving

 

[drrosenrosen]

And yet, the difference to non-RVU people is massive: $5800 for an in-office kyphoplasty, $460 professional fee for Intracept (since it has to be done in a hospital)

 

[Tboned]

I’ve done all mine in ASC setting although I am in the process of setting up OR time at a hospital for certain payors

 

[epidural man]

Regarding Intracept - and somewhat of a thread hijack (but is it worthy of it's own thread you ask?).....

I was told when trained that they need to be done under general anesthesia -

But the last one I did, the rep told me about 60% of the cases he sees being done are under sedation/MAC.

That means I could do them in my clinic which is WAY easier than trying to get OR time.

Who is doing them without general anesthesia? Pearls of wisdom? What and how are you localizing?

 

[RoloTomassi]

I do majority of cases MAC. MAC is plenty sufficient IMO. Only reasons for general is airway protection / comirbidities / long case ie L1-S1.

I've done about 10 IV conscious, who tolerated well. Have to be the right patient though, not the ones who would scream during an MBB.

Keep in mind in you can't bill MC/insurance in office.

 

[epidural man]

I do majority of cases MAC. MAC is plenty sufficient IMO. Only reasons for general is airway protection / comirbidities / long case ie L1-S1.

I've done about 10 IV conscious, who tolerated well. Have to be the right patient though, not the ones who would scream during an MBB.

Keep in mind in you can't bill MC/insurance in office.

Do you try to localize the vertebral bone, and the pedicle bone as you mallet your way to the destination? How do you do that? I've considered dropping a long 22g spinal through the canula.

 

[Tboned]

In fellowship, only used general. In practice I’ve only used MAC for sedation, which is all handled by an anesthesia team. No problems with MAC so far but agree with @RoloTomassi that general may be needed in certain situations.

Do you try to localize the vertebral bone, and the pedicle bone as you mallet your way to the destination? How do you do that? I've considered dropping a long 22g spinal through the canula.

I’m not quite understanding what you mean by localizing the vertebral bone and the pedicle bone or how dropping a 22g through the cannula would be helpful. Please clarify.

 

[drrosenrosen]

Hijacking the hijack - I have been very impressed with the effectiveness of the procedure. I have however been profoundly unimpressed with the supposed authorization assistance provided by Relievant. I have had 3 BCBS pts denied, closed, no further appeal, while my partner has somehow managed to get a few BCBS cases done. The company is next to worthless in terms of helping with the appeal process.

 

[fathead88]

Bills less than Kypho and takes longer - as above 7.15 for one level (two vertebrae), 3.77 for additional level. From a billing perspective it is worth it if you have easy access to OR.

 

[Tramadeezy]

What insurances are covering this??

 

[epidural man]

In fellowship, only used general. In practice I’ve only used MAC for sedation, which is all handled by an anesthesia team. No problems with MAC so far but agree with @RoloTomassi that general may be needed in certain situations.

I’m not quite understanding what you mean by localizing the vertebral bone and the pedicle bone or how dropping a 22g through the cannula would be helpful. Please clarify.

As an anesthesiologist - I would say MAC sedation only works great IF the proceduralist can do a good job numbing the area...otherwise, you basically are doing a general anesthetic with a natural airway, which is less than ideal in a prone case.

So the question is - how are numbing up the pedicle and the vertebral bone? If you are not, I suspect the patient is basically knocked out.

 

[callmeanesthesia]

As an anesthesiologist - I would say MAC sedation only works great IF the proceduralist can do a good job numbing the area...otherwise, you basically are doing a general anesthetic with a natural airway, which is less than ideal in a prone case.

So the question is - how are numbing up the pedicle and the vertebral bone? If you are not, I suspect the patient is basically knocked out.

I do kypho in office with local and oral sedation. Numb the periosteum and they’re generally ok. I don’t do Intracept so I don’t know how painful the burn itself is.

 

[Tboned]

As an anesthesiologist - I would say MAC sedation only works great IF the proceduralist can do a good job numbing the area...otherwise, you basically are doing a general anesthetic with a natural airway, which is less than ideal in a prone case.

So the question is - how are numbing up the pedicle and the vertebral bone? If you are not, I suspect the patient is basically knocked out.

I drop a large amount of local in the skin, soft tissues and on os. I don’t use any intraosseous local.

 

[RoloTomassi]

I drop 22 ga to target to map out trajectory.

Then numb pedicle 5 mL lido 1% on/under periosteum, 5 mL more during pullout. Optional wheal of lido w/epi at skin before stab incision.

No lido after that. Bone too vascular for comfort.

A little discomfort going through VB cortex, usually not bad. If this is hard, use hand drill, much less painful than hammering harder.

When stylet approaches BVN until when it crosses SP, there are 2-3 taps that are the most painful part of the procedure. It's only a few seconds. Burn is surprisingly not very painful, like a 7 min RFA.

That's my n=10.

 

[MD87]

I have done only a couple cases. Neither patient was large but not thin either. Both cases went well but slow as they were my first. Anesthesia felt comfortable using an LMA. They said if patient was larger would need to intubate. I imagine for shorter cases and once you are more experienced and can finish the procedure faster general isn’t needed in the right patient. I am very anti sedation for most procedures… pretty sure I would personally want to be out for this one if I were on the table.

 

[Taus]

Another gem from LinkedIn…. Scs implanted for this. A one and done 40 minute procedure with no implant or future maintenance vs scs. Which would you rec for your family?

 

[Tboned]

Just saw that post too and was thinking the same thing!

 

[Taus]

Just saw that post too and was thinking the same thing!

That is an otherwise pristine spine with one crappy level at L5-S1, including some anterolisthesis. I would suspect some motion on flexion-extension standing x-rays. I would actually probably suggest they consider a fusion over Scs in this scenario.

 

[MD87]

Stim -> remove stim -> fuse -> new stim?

 

[MitchLevi]

Ride that disk and let that L5-S1 level evolve. May stop hurting. PT and a good handshake.

A clinic visit where you really open up to that pt..."My wife loves Yellowstone! Great show!"

 

[Asclepius186]

Another gem from LinkedIn…. Scs implanted for this. A one and done 40 minute procedure with no implant or future maintenance vs scs. Which would you rec for your family?

Yep if I was the patient I would try some epidurals, but if no dice, then go for one level fusion. But I’ve never really understood Why people do SCS for back or radicular pain without a prior operation. Back surgery is actually indicated sometimes.

 

[bedrock]

That is an otherwise pristine spine with one crappy level at L5-S1, including some anterolisthesis. I would suspect some motion on flexion-extension standing x-rays. I would actually probably suggest they consider a fusion over Scs in this scenario.

Agree there is likely additional motion. However also endplate changes.

I’d definitely recommend intracept for this patient over scs or a fusion.

 

[Ducttape]

Does this patient really need an injection?

What about some lifestyle changes, exercise, and realize that "Life is pain, Highness"....