I wouldn’t call that the pain coming back… I would call that just a total failure.
No new changes on MRI? Doesn’t Intracept produce some lesions on MRI? Maybe they didn’t burn long enough.
done 200+ cases. Success rates still mirror literature. Key is classic symptoms and imaging. Success decreases when deviate. Commercial insurance coverage still poor. Still pays peanuts in pro fee. Only viable at higher volumes for docs who own asc/hopd until commercial insurance coverage/rates come around.
Can you describe your selection process?
Well said.
I’m over 100 with all but 5 in the HOPD procedure suite with a little iv sedation(100ug fentanyl or less). I would echo that results follows the literature. It’s not a great time value for me but it mostly works. My usual time for a 2 vertebral body case is 25 minutes , but I refuse to do any cases in the or due to anesthesia turnover essentially. Almost solely Medicare cases at this point. Humana Medicare has covered it and we have done a few Aetna Medicare after lengthy appeal process.
You think that commercial will come around. I am skeptical
They have a little bit… Cigna came on board a couple years ago, which was huge, it was then unfortunatelylost when they transitioned to evicore for all their interventional pain authorizations. Carelon has a positive written coverage coverage policy. Several of the different state/region specific blues around the country have positive coverage. I just got an approval with United for the first time. Aetna has been 0%. My main local Blue Cross is unfortunately a no go despite them using Carelon for their other pain/spine procedures. Highmark covers. Tricare covers. Humana covers. Traditional Medicare. Granted, the largest group of prototypical patients have commercial insurance.
This sounds right. I would think younger patients with classic symptoms and only 1-2 level modic changes with little else would respond best. Makes sense then that @SC Tian wouldn't see stellar results if older patient population with concomitant facet arthropathy, multifidi atrophy, long standing disc degeneration and listhesis and possible instability.
That’s been my experience as well, with a mostly Medicare aged population. For those patients I discuss the literature based rates but I do warn them that in their case, with multiple potential sources of spine pain, they're unlikely to get total relief.
Can someone please explain where BVNA fits in with your treatment approach? Most of my patients have modic changes, but I usually would be exhausting RFA and epidurals first.
Same. Although wouldn’t necessarily say most of my patients have Modic changes. I’ll always try MBB/RFA first since that is less invasive and well documented in the literature to be not predictable based on PE or imaging (and much better reimbursement for the time spent).
I would focus on the population under 50 with one to two level modic changesand midline axial lbp
This was also my understanding. I guess I just don’t see enough patients or maybe my patients are just older and other pain generators are more dominant than this. Thanks
I do see some Medicare patients who are a good candidates for this, but that small percentage is the exception and majority are younger with commercial insurance. Problem is… majority of those younger patients cannot get it approved by their insurance. It is incredibly frustrating, as I get a lot of referrals for it, including many from spine surgeons on patients who have truly failed all else.
Talk to your Boston rep. New kits are in, my cases tomorrow are good to go.
What's the scuttle butt on the recall? Seems to have hit their RF products across the line
Something about the outer tray seal out of spec. Nothingburger.
Yeah, I haven't had that issue with Stryker's system as their introducer is a lot more robust, but every patient/physician is different.Something about the outer tray seal out of spec. Nothingburger.
Given Taus experience with Stryker and this, I would not chance it. Hard bone is not uncommon.
#intracept #optablate #bvna #510k | Edward (Joe) Kent III, MD | 12 comments
I rarely post on LinkedIn, but my experience in the OR today was too egregious to ignore. With the recent voluntary recall of the basivertebral nerve ablation #Intracept system by Boston Scientific, I had the opportunity to try a competitor over the last week. I did my first five #Optablate...www.linkedin.com
I did. There was some shipping issue with my kits and they weren’t sent out Friday as planned, they were sent out today and now won’t arrive on time
Over my state, United Health approves Intracept but does not reimburse the kit. They do not consider Intracept as implant material. Have you encountered this issue before? Thanks.
Yeah, I think they reimbursement is set to include the cost of the kit but I'm a simple hospital based doc. As there isn't a real implant here per se to transfer the cost on like in an SCS IPG or cement, it should be okay, but you're just looking now for the cheapest/best consumable.
Only done that one case that got approved recently. Not sure re facility fee. Will ask.
I had a Stryker trocar break off in a patientSomething about the outer tray seal out of spec. Nothingburger.
Given Taus experience with Stryker and this, I would not chance it. Hard bone is not uncommon.
#intracept #optablate #bvna #510k | Edward (Joe) Kent III, MD | 12 comments
I rarely post on LinkedIn, but my experience in the OR today was too egregious to ignore. With the recent voluntary recall of the basivertebral nerve ablation #Intracept system by Boston Scientific, I had the opportunity to try a competitor over the last week. I did my first five #Optablate...
Wow, mid shaft? Were you able to retrieve it?
United Health only reimbursed a facility fee of $3,000 in an ASC setting here.
Wow… looks like they won’t let me do any more when they see that..
Tip of J/curve or access cannula/trochar?
Glad you got through the case, good call on the 8g. That is what I used when I was forced to use them again due to the recall. I also took larger angles than typical just in case I had rock hard bone and could not get the J/peak through without bending/kinking again. I also firmly gripped the exposed part of J outside trochar and was very careful that all hard mallet strikes were square to avoid bending it again there on hard bone. It did work ok that way.
Patient had it removed by a tertiary care hospital, however it was essentially a pedicle screw at that point.
Apologies if this has already been mentioned, but apparently there is some emerging literature regarding better/more durable outcomes in patients with Modic 1 changes as opposed to Modic 2. I have anecdotally seen this in my practice but my n=30. As you all know, the patients with Modic 1 are typically younger with commercial insurance and so much harder to get insurance approval -- but for us the Intracept portal has been very clutch in this regard. However I still try MBBs first almost always.
