Lumbar RFA vs Facet Injection Reimbursement... is RFA worth it?

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TeslaCoil

TeslaCoil

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I was looking at fee schedules yesterday and saw that 3 level Lumbar RFA reimbursement is $1750 for hospital setting, and only ~$800 for ASC or physician office. Facets reimburse around half that much but take half, or less than half, the time it takes to do an RFA. If doing RFA in a physician office or ASC financially worth it? Why the discrepancy in reimbursement between hospital setting and physician clinic? Thanks!
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TeslaCoil said:
I was looking at fee schedules yesterday and saw that 3 level Lumbar RFA reimbursement is $1750 for hospital setting, and only ~$800 for ASC or physician office. Facets reimburse around half that much but take half, or less than half, the time it takes to do an RFA. If doing RFA in a physician office or ASC financially worth it? Why the discrepancy in reimbursement between hospital setting and physician clinic? Thanks!
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RFA is superior to facet CSI bc it lasts longer and spares you exposure to steroids.
 
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it can be problematic getting approval for therapeutic facet joint injections.

most carriers will allow diagnostic facet joint/median branch injections but not therapeutic, and evidence supports that radiofrequency is better treatment that facet injections.
 
When billing for facet injections I was under the impression that you could only bill for 3 levels on one side or two levels bilaterally... is that true?
 
Ducttape said:
it can be problematic getting approval for therapeutic facet joint injections.

most carriers will allow diagnostic facet joint/median branch injections but not therapeutic, and evidence supports that radiofrequency is better treatment that facet injections.
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agree on both. Many insurance carriers these days are really discouraging facet joint injections. And many of the ones that allow IA facets, will only allow them for a diagnostic injection X 1, not repeats.

Regarding the finances, I definitely noticed that as well. I trained with some people who were national experts in RFA, yet they did much much less RFA than I expected. Possibly because an IF facet 2-3 times a year pays better than an annual RFA, and is quicker.
 
Honestly i think intra-articular facet injections can be pretty challenging..IF you actually try to truly get into the joint. Especially in people over 60. I go back and forth on this topic and unfortunately it comes down to protoplasm. If I can hedge the patients comprehension on the way mbb to rfa pathway works, and they are over 60, I will talk to them about it. But if I walk in that room and my gut tells me I’m gonna be wasting my time with spine models, showing them X-ray/mri and them still thinking I’m talking about an “epidermal” then I’m probably gonna do an IA facet and hope for the best and call it a day. I’ve gotten to the point where I cherish smooth patient encounters over constantly thinking about the practicality/economics of the encounters.

Also it’s true many insurances will not approve IA facets anymore anyway.
 
TeslaCoil said:
I was looking at fee schedules yesterday and saw that 3 level Lumbar RFA reimbursement is $1750 for hospital setting, and only ~$800 for ASC or physician office. Facets reimburse around half that much but take half, or less than half, the time it takes to do an RFA. If doing RFA in a physician office or ASC financially worth it? Why the discrepancy in reimbursement between hospital setting and physician clinic? Thanks!
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No, just stim it.

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How Does ReActiv8 Work? Many studies show that restoration of muscle activation is an important step in the treatment of chronic low back pain.1,2 ReActiv8 is a small implanted device which stimulates the nerves responsible for activating the key muscles that stabilize the lower back.
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I just go with the mantra of taking care of the patient. Do the best for them and then the money follows.
If your offfice was all giving only short term relief from steroid injections yet I am in the same town where patients get longer relief from RFA, your patients will find me and stay away from you.
reputation matters
 
Dr. Ice said:
Honestly i think intra-articular facet injections can be pretty challenging..IF you actually try to truly get into the joint. Especially in people over 60. I go back and forth on this topic and unfortunately it comes down to protoplasm. If I can hedge the patients comprehension on the way mbb to rfa pathway works, and they are over 60, I will talk to them about it. But if I walk in that room and my gut tells me I’m gonna be wasting my time with spine models, showing them X-ray/mri and them still thinking I’m talking about an “epidermal” then I’m probably gonna do an IA facet and hope for the best and call it a day. I’ve gotten to the point where I cherish smooth patient encounters over constantly thinking about the practicality/economics of the encounters.

Also it’s true many insurances will not approve IA facets anymore anyway.
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Ha we must have similar patients. Going over MBBs ad nauseam with patients only to have them tell you the shot didn’t work because their “pain came right back” is so frustrating
 
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manowar rules said:
Ha we must have similar patients. Going over MBBs ad nauseam with patients only to have them tell you the shot didn’t work because their “pain came right back” is so frustrating
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What amazes me is I’d leave the room thinking I did a bang-up job of explaining the process with emphasis on temporary and diagnostic, and 80% of the patients are surprised on procedure day that they’re not having their nerves burned. I think once you mention nerve burning everything else out of your mouth is Charlie Brown waa waa waa noises.
 
Orin said:
No, just stim it.

How Does ReActiv8 Work? | Mainstay Medical

How Does ReActiv8 Work? Many studies show that restoration of muscle activation is an important step in the treatment of chronic low back pain.1,2 ReActiv8 is a small implanted device which stimulates the nerves responsible for activating the key muscles that stabilize the lower back.
mainstay-medical.com mainstay-medical.com
Click to expand...
Stim axial back pain? Like what with Medtronic DTM?
 
Agast said:
What amazes me is I’d leave the room thinking I did a bang-up job of explaining the process with emphasis on temporary and diagnostic, and 80% of the patients are surprised on procedure day that they’re not having their nerves burned. I think once you mention nerve burning everything else out of your mouth is Charlie Brown waa waa waa noises.
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What is even more amazing is when the patient does not have pain relief with the diagnostic block yet ask (more than once)
“So the next step is the laser to burn my nerves right?”
🤦‍♂️
 
If u have a 25 year old girl with really bad facets, classic axial pain, failed all treatments (pt/meds/wait) would you do an rf or just inject the joints with steroid?
 
painfree23 said:
If u have a 25 year old girl with really bad facets, classic axial pain, failed all treatments (pt/meds/wait) would you do an rf or just inject the joints with steroid?
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absent trauma, there really are no 25 y/o girls with "really bad facets"

id start with facet steroids and repeat a few times, before begrudgingly RFA if I have to
 
SSdoc33 said:
absent trauma, there really are no 25 y/o girls with "really bad facets"

id start with facet steroids and repeat a few times, before begrudgingly RFA if I have to
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Had a bad pars defect from a while
ago, stable on flex/ex films, some scoli, maybe that’s contributing? Surgeons aren’t touching her (obviously)
 
painfree23 said:
Had a bad pars defect from a while
ago, stable on flex/ex films, some scoli, maybe that’s contributing? Surgeons aren’t touching her (obviously)
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Thats different. Id RF that
 
painfree23 said:
What if she was an athlete?
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Sure. RF will make her more athletic. Those multifidi arent doing anything anyway. I haven't seen the best success with RF and pars defects, but you dont have much to lose in that back
 
SSdoc33 said:
Sure. RF will make her more athletic. Those multifidi arent doing anything anyway. I haven't seen the best success with RF and pars defects, but you dont have much to lose in that back
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I think we need more discussion of this athletic 25 year old girl. Pictures please
 
callmeanesthesia said:
The spondy is most likely L4-5 or L5-S1. Isolated RF at one of those levels should minimally impact multifidus strength. Just leave the L2 medial branch alone if you can.
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Agree that RF has minimal impact on spine muscle strength.
I would very rarely RF L2 in a non elderly spine, but why do you feel we should leave it alone?
 
bedrock said:
Agree that RF has minimal impact on spine muscle strength.
I would very rarely RF L2 in a non elderly spine, but why do you feel we should leave it alone?
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Always gives the strongest twitch when motor testing, with L3 being a close second, so I reason that it will preserve the most strength of the multifidus muscle to help stabilize that spondy if left alone.
 
callmeanesthesia said:
Always gives the strongest twitch when motor testing, with L3 being a close second, so I reason that it will preserve the most strength of the multifidus muscle to help stabilize that spondy if left alone.
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Your personal observations are not science and should not be misconstrued for data.
 
painfree23 said:
Is doing a lumbar RFA in an athlete the best for the patient?
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This is where clinical reasoning comes in. Young athlete - I wouldn’t jump to RFA. I would do one time facet block, they’re not old and degenerated. Athlete as in 60 year old avid tennis or golf player who is getting frustrated he can’t play as much anymore? RFA away.
 
Fairly certain the answer is no, but is there any evidence that RF at the level of a spondy leads to progression of spondy?
 
Young people respond to steroid. Decent responses can be had with injections around/in facet joints in younger people. I'd inject it a few times and give exercise instructions if there is a curve before jumping to RF.
 
painfree23 said:
Does it specifically matter for insurance if I do lumbar medial branch or facets (if no plans for RF)
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Many insurances no longer allow therapeutic facet steroid injections. If they do, it is usually only when a prior facet injection has given >3 months relief.
 
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