L3-L4, L5-S1 RFA

[painquestions8989]

Is it okay to bill this as a two-level RFA, despite needing four needles? My understanding of anatomy is that this is okay to do while providing broader coverage.

However I am getting major pushback from billing/admin and the case was even escalated to "risk management" to ensure no "fraud" as they think I am performing RFA on three levels. I work for a hospital system. Thank in advance.

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[Agast]

I do this for the patients who need it. It’s also probably why the 3-level billing went away

Fraud is when you claim to deliver a service and you do not

 

[painquestions8989]

Unfortunately people with little knowledge of anatomy and medicine are dictating my practice & possibly my future by escalating the situation. Not sure how to handle this other than giving up and moving on (I'm not RVU based).

 

[DOctorJay]

Sit them down with a spine model and show them the joints you’re treating and where the nerves are that innervate those joints.

As long as you’re only billing the codes they can’t call it fraud or medically unnecessary.

 

[Taus]

I don’t really think it makes a difference. you either dictate it as L34, Ls-s1, or dictate you did all three joints, and just bill for two levels.

 

[painquestions8989]

you either dictate it as L34, Ls-s1, ..., and just bill for two levels.

That's exactly what I did... glad I'm not the only one that thinks it's obvious and these people are inept.

 

[SSdoc33]

Clipboard nurses.

It might not be worth the fight. Would you play a monkey in a game of chess?

 

[MitchLevi]

What you're doing is an L3-S1 RFA, so dictate it that way and bill a two level.

You're doing what every single pain doctor in America is doing - Giving away a free needle.

There's no fraud here...Period.

You can bill L3-5 or L4-S1...Does not matter.

 

[painquestions8989]

What you're doing is an L3-S1 RFA, so dictate it that way and bill a two level.

You're doing what every single pain doctor in America is doing - Giving away a free needle.

There's no fraud here...Period.

You can bill L3-5 or L4-S1...Does not matter.

No way in hell the hospital lets me "underbill" and give away a needle.

 

[knoxdoc]

The only fraud is you getting hosed out of a level.

 

[PMROralBoards]

What you're doing is an L3-S1 RFA, so dictate it that way and bill a two level.

You're doing what every single pain doctor in America is doing - Giving away a free needle.

There's no fraud here...Period.

You can bill L3-5 or L4-S1...Does not matter.

Under billing is considered fraud. Charting and billing a two level RFA (l3-l4, l5-s1) is not fraud. Calling the latter “fraud” would be the same as calling it fraud to bill for an MBB while not also billing trigger point injections despite putting a needle into >3 muscles.

 

[SgtThunderfistMD]

What you're doing is an L3-S1 RFA, so dictate it that way and bill a two level.

You're doing what every single pain doctor in America is doing - Giving away a free needle.

 

[MitchLevi]

Under billing is considered fraud. Charting and billing a two level RFA (l3-l4, l5-s1) is not fraud. Calling the latter “fraud” would be the same as calling it fraud to bill for an MBB while not also billing trigger point injections despite putting a needle into >3 muscles.

Not fraud.

 

[Ducttape]

copy the MRI scan results in to your note and document that you reviewed the MRI and see significant facet arthropathy at the L34 and the L5S1 levels on MRI imaging and "MRI findings are concordant to patient's physical findings".

i would not document "doing 3 level RFA" or "3 levels involved" or "L3-S1" or anything like that. you are only treating 2 levels. if a 3rd is affected, cie la vie.

 

[cowboydoc]

i would not document "doing 3 level RFA" or "3 levels involved" or "L3-S1" or anything like that. you are only treating 2 levels. if a 3rd is affected, cie la vie.

This.

I've had a few insurances give push back on prior auth for doing 3 but billing 2 levels, so I clearly state L3-4 and L5-S1 joint for accuracy. I don't get in the weeds with imaging correlation at these specific levels, because we all know that would be an odd pattern.

 

[SpineandWine]

See if your hospital would charge cash price for extra level - if not unreasonable, have the patient sign a form
Or tell hospital you’ll send those patients out to PP doc who can do this

 

[painquestions8989]

To close the loop, this was escalated to the head of billing. I sent a straightforward question, 'if performing an rfa on two non-adjacent levels L3-L4, L5-S1, would you bill for the third "skipped" level in between?' made it pretty dummy proof for them to say, of course not, just bill for two levels and proceed.

 

[TIVAndy]

explain the situation to patient, have them sign non covered waiver and collect the extra 30-50 bucks.

 

[MitchLevi]

It is complete BS they don't pay for 3 levels.

Probably half my RFAs are L3-S1.

 

[SpineandWine]

It is complete BS they don't pay for 3 levels.

Probably half my RFAs are L3-S1.

If in office, usually you can charge for additional level since no longer covered

 

[MitchLevi]

If in office, usually you can charge for additional level since no longer covered

What you mean?

 

[Orin]

So the legal people will tell you that under coding and over coding are equally problematic. In reality, that's not true. The issue they argue if you under code, so the patient gets more for their money, you may be inducing them to come back to you more.

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