is a racz type catheter "lysis"?

[NEPain]

If I use an epidmed or codman introducer and catheter through a caudal approach for someone who has had multiple back surgeries, is that considered lysis of adhesions? Is it just a plain old caudal?
Is there anything I can bill to justify the time and expense involved? I always thought it was a nice procedure and I'm being road blocked by our billing people.

I could use some ammo if there is any...

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[lobelsteve]

I'd call it a caudal.

If using a Target or Myelotec cath, than I'd bill as adhesiolysis.

 

[Jcm800]

If I use an epidmed or codman introducer and catheter through a caudal approach for someone who has had multiple back surgeries, is that considered lysis of adhesions? Is it just a plain old caudal?
Is there anything I can bill to justify the time and expense involved? I always thought it was a nice procedure and I'm being road blocked by our billing people.

I could use some ammo if there is any...

if use a racz catheter and you do lysis, meaning actually do mechanical manipulation, or volume lysis, or inject hyaluronidase, then it is a lysis.

If you put the catheter in and then just injection, thats a caudal. dont use a Racz for caudal, it is not cost effective...

 

[NEPain]

I'm not just inserting and injecting. I'm trying to manipulate the catheter to the area of pathology. This might be in a patient who has multiple fused segments in the lower lumbar spine. I can push through adhesions and inject into multiple areas if I want. I can see the contrast contained by something (scar tissue?) and I'm able to push past it. Is that lysis?
For a plain caudal I just use a 22 quincke or 20 ga tuohy and squirt.

 

[Jcm800]

I'm not just inserting and injecting. I'm trying to manipulate the catheter to the area of pathology. This might be in a patient who has multiple fused segments in the lower lumbar spine. I can push through adhesions and inject into multiple areas if I want. I can see the contrast contained by something (scar tissue?) and I'm able to push past it. Is that lysis?
For a plain caudal I just use a 22 quincke or 20 ga tuohy and squirt.

you should inject contrast first, look for the "filling defect" then you put the catheter up there and break up the adhesion, then put more contrast and look for "extension of contrast" to indicate epidural adhesions have been lysed, as evidenced by spread of contrast to areas previously not seen. You need to do AT LEAST that for it to be lysis.

the question is do you really believe this works, I actually do, but for how long...
do you "break up adhesions" that come back tomorrow? i dunno. But when done properly, and it takes a bit of time, much more than just a site/catheter directed caudal ESI, i think it works better than any other ESI in these Post-lam patients with radicular pain who did not get better with a simple TFESI...

a small subset of people IMO...

so to answer your question, if you put contrast in first, then do what you do, and actually TRY to break up adhesions, and document some more contrast and better spread, then yes...


but as exactly described by, i would say no.

 

[Doctodd]

you should inject contrast first, look for the "filling defect" then you put the catheter up there and break up the adhesion, then put more contrast and look for "extension of contrast" to indicate epidural adhesions have been lysed, as evidenced by spread of contrast to areas previously not seen. You need to do AT LEAST that for it to be lysis.

the question is do you really believe this works, I actually do, but for how long...
do you "break up adhesions" that come back tomorrow? i dunno. But when done properly, and it takes a bit of time, much more than just a site/catheter directed caudal ESI, i think it works better than any other ESI in these Post-lam patients with radicular pain who did not get better with a simple TFESI...

a small subset of people IMO...

so to answer your question, if you put contrast in first, then do what you do, and actually TRY to break up adhesions, and document some more contrast and better spread, then yes...


but as exactly described by, i would say no.

hey DocShark.....what catheters do you use? Im doing more of these cuz of the increasing number of LFBSS i see

 

[Jcm800]

hey DocShark.....what catheters do you use? Im doing more of these cuz of the increasing number of LFBSS i see

Racz catheter. i cant get anyone to sell me anything better that is cheaper. They arent cheap. Would love another option...

 

[NEPain]

OK, so I need to talk with my billing people again. If you have a chance to privately email codes it would be really helpful in dealing with these obstinate people.

An alternative to the racz catheter is made by codman. It's called the agile cath and it's pretty darn good and I think a lot cheaper.

 

[Jcm800]

OK, so I need to talk with my billing people again. If you have a chance to privately email codes it would be really helpful in dealing with these obstinate people.

An alternative to the racz catheter is made by codman. It's called the agile cath and it's pretty darn good and I think a lot cheaper.

Thanks I will look into that catheter

 

[NEPain]

Let me know if you need contact info.

 

[Jcm800]

Let me know if you need contact info.

if you have, could you please share it with me. PM is good. thanks

 

[Doctodd]

how often to do a RACZ. Patient came back today and said he hasnt felt this good for 3 years so he is walking 1.5 miles before his pain comes back. He is 76 so i obviously talked about modifying that. But he insisted on another one.

 

[Jcm800]

how often to do a RACZ. Patient came back today and said he hasnt felt this good for 3 years so he is walking 1.5 miles before his pain comes back. He is 76 so i obviously talked about modifying that. But he insisted on another one.

I think pretty much same as any esi...I have patients who that's what they get when they need an intervention. Vi have one lady who comes twice a year... I tried an esi on her looking to see if it was the lysis or just the esi that made the difference. She swore the tfesi helped only a fraction of the es. Had a few like that. I don't do it daily, but once a week maybe. Shockingly, I rarely see post laminectomy new patients anymore, wonder where they are going? Actually I don't. I know they typically get sent to the competitor who is loose TIH the narcs...

 

[cowensx2]

As of 2012 a caudal with Racz catheter is considered the same as a regularcaudal.

You use to be able to bill for "mechanical lyses of adhesions" butas of 2012 codes they only way to bill for mechanical lyses of adhesions is tokeep them in for 24 hours to i.e. if less than 24 hours then plain caudal.

Catheter or needle recognized as a straight caudal.
I use tobill for mechanical lyses all the time but will be rejected as of 2012. Just another way for them to cut reimbursementwithout stating they are cutting reimbursement

 

[Doctodd]

EOB came back today....finally, even though MC already paid the 72275 and the visit. In the future i will do the same thing but bill as a TFESI. I think in the past it was coded more often by the old salty pain docs......none of the FP's and fly-by-night pain docs were doing these. Hence, there was no 1000% increase in 62264's like there was for ESI's and facets.

 

[Jcm800]

Has anyone else heard this? I am not aware of this, doesn't mean it isn't true...

As of 2012 a caudal with Racz catheter is considered the same as a regularcaudal.

You use to be able to bill for "mechanical lyses of adhesions" butas of 2012 codes they only way to bill for mechanical lyses of adhesions is tokeep them in for 24 hours to i.e. if less than 24 hours then plain caudal.

Catheter or needle recognized as a straight caudal.
I use tobill for mechanical lyses all the time but will be rejected as of 2012. Just another way for them to cut reimbursementwithout stating they are cutting reimbursement

 

[facets]

EOB came back today....finally, even though MC already paid the 72275 and the visit. In the future i will do the same thing but bill as a TFESI. I think in the past it was coded more often by the old salty pain docs......none of the FP's and fly-by-night pain docs were doing these. Hence, there was no 1000% increase in 62264's like there was for ESI's and facets.

Wait a minute u can't do that, thats fraud even though it is the same price or a lower price. You will get in a lot of trouble billing a caudal as a TFI, the caudal canal is not a neural foramen. I hope you meant you will be it as a caudal. I have done that because most insurance companied don't cover lysis, u eat the cost of the catheter and lytic solutions. These days, I can't afford to "eat:" anything

 

[Doctodd]

i dont do caudals unless i have absolutely no other option....i go thru S1 or S2 foramen. It is correct either way. But hey .....thanks for announcing that on here. And yes i did eat it. Lost about $27 for the Wydase.

 

[facets]

Better me than Medicare, you don't want to mess with them. The people who do audits go by the textbook description

 

[Doctodd]

then i guess they owe me money cuz a TFESI pays more

 

[Jcm800]

then i guess they owe me money cuz a TFESI pays more

isnt it funny, that they dont audit and say, hey we owe Dr. Todd money, he underbilled!

But gawdforbid you erroneously overbill, its a federal crime.

 

[Ligament]

isnt it funny, that they dont audit and say, hey we owe Dr. Todd money, he underbilled!

But gawdforbid you erroneously overbill, its a federal crime.

Its a federal crime to underbill too!

 

[Jcm800]

Its a federal crime to underbill too!

either way, they aint coming at you to give you money back!

 

[facets]

The problem is they have vigilantes who get a commission on any "overpayment" They ignore underpayments take any technical flaw in your records assess the overpayment say $50, then multiply it by the number of times you did that procedure over the last few years and assess your penalty. Its the most oppressive system. Another thing that is just totally wrong. If you Dr Todd find an underpayment you have only 6 months for a timely claim whereas they have 4-5 years to come back at you. So you got paid "incorrectly" they recoup the money but its too late to file the correct claim. I have had this happen with Cigna. They came back 4 years later and determined that they should not have been the primary insurance even though the patient was working full time, MC should have paided. So they took back the money and told us to bill MC, yeah right too late.
You just want to follow the rules, use the same terminology they do because the auditors sure are not pain docs, be very clear in your dictation so there is no ambiguity and reason to harass you.

 

[PinchandBurn]

.

 

[Jcm800]

I asked my coders to research this, and they say there is no change to the code. If you bil 62264 it does not have to be 24 hours, not sure where you got that info, but plead provide a source. To my knowledge, it's all the same as last year. Mechanical lysis is lysis and needn't be 24 hours...

 

[NEPain]

As the author of the OP, I appreciate all the comments. I think that the way I've done it qualifies as lysis (unless the 24 hour rule is true). Ultimately, this is the type of BS that makes me just not do the procedure, even though I think it's a good procedure that helps people. I risk a huge penalty, it takes a lot of time to do correctly. I'm so sick of worrying about what I'm "allowed to do". Practicing medicine has just become so onerous compared to 25 years ago. It certainly isn't better. The money has just been redistributed and the care is poorer and we're all scared.
Sad. Thanks for all the replies. I think I'll just beg our billing people to call all our insurers and see if they pay for this. The Codman agile cath is nice and was a lot cheaper as of a few years ago anyway.

 

[PinchandBurn]

for medicare patients do you guys Prior Auth for this procedure? I'm assuming just for commercial payors is when we have to prior auth like with most other things?

 

[Jcm800]

As the author of the OP, I appreciate all the comments. I think that the way I've done it qualifies as lysis (unless the 24 hour rule is true). Ultimately, this is the type of BS that makes me just not do the procedure, even though I think it's a good procedure that helps people. I risk a huge penalty, it takes a lot of time to do correctly. I'm so sick of worrying about what I'm "allowed to do". Practicing medicine has just become so onerous compared to 25 years ago. It certainly isn't better. The money has just been redistributed and the care is poorer and we're all scared.
Sad. Thanks for all the replies. I think I'll just beg our billing people to call all our insurers and see if they pay for this. The Codman agile cath is nice and was a lot cheaper as of a few years ago anyway.

i just got some agile caths, thanks for the tip. I say keep doing. We get paid for medicare, but NO ONE ELSE...