MBB and RFA

[med7343]

whats the typical work flow for the MBB and RFA for you guys?
MBB-office visit- MBB- office visit- RFA-Office visit
or do you get MA to call after the MBB for percent relief
also it appears we have to do the ODI before and after the MBB's and RFA
I am trying to see how i can streamline the process without insurance disapprovals
thanks

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[knoxdoc]

Office visit to discuss both MBB and potential subsequent RFA. Give paperwork describing the procedures. Schedule MBB#1.
Do MBB #1, staff calls next day to get pain log, shows me results. If no go, schedule f/u. If good, schedule MBB#2 in 2 weeks.
Do MBB#2, briefly describe RF again right after the MBB#2. Offer Valium for the RF. Then staff calls next day to get pain log, shows me results. If good, schedule RF.

 

[mdo1738]

99204
MBB #1
99213
MBB #2
99213
RFA

 

[med7343]

Office visit to discuss both MBB and potential subsequent RFA. Give paperwork describing the procedures. Schedule MBB#1.
Do MBB #1, staff calls next day to get pain log, shows me results. If no go, schedule f/u. If good, schedule MBB#2 in 2 weeks.
Do MBB#2, briefly describe RF again right after the MBB#2. Offer Valium for the RF. Then staff calls next day to get pain log, shows me results. If good, schedule RF.

do you do ODI after every procedure as well

 

[oneforfighting]

Office visit to discuss both MBB and potential subsequent RFA. Give paperwork describing the procedures. Schedule MBB#1.
Do MBB #1, staff calls next day to get pain log, shows me results. If no go, schedule f/u. If good, schedule MBB#2 in 2 weeks.
Do MBB#2, briefly describe RF again right after the MBB#2. Offer Valium for the RF. Then staff calls next day to get pain log, shows me results. If good, schedule RF.

Do same except schedule f/u after MBB#2

 

[kstarm]

99204
MBB #1
99213
MBB #2
99213
RFA

Why?

 

[callmeanesthesia]

PEG score. 3 items. Recorded every visit. Medicare says a functionality score “including but not limited to” ODI, etc.

https://health.gov/hcq/trainings/pathways/assets/pdfs/PEG_scale.pdf

office visit to order first MBB
MBB
f/u visit (1-3 days later)
MBB 2 (2 wks later)
f/u visit (1-3 days later)
RFA (next available)
f/u visit.

 

[so55b]

PEG score. 3 items. Recorded every visit. Medicare says a functionality score “including but not limited to” ODI, etc.

https://health.gov/hcq/trainings/pathways/assets/pdfs/PEG_scale.pdf

office visit to order first MBB
MBB
f/u visit (1-3 days later)
MBB 2 (2 wks later)
f/u visit (1-3 days later)
RFA (next available)
f/u visit.

I mean this will definitely help my rvu.. but not sure if it is really necessary to do follow ups after mbbs. I would feel sorry for my patients and feel kinda unethical to do so. I let my patient call after each mbbs and update my note for next mbb or rfas.

 

[Ronin1]

If you have a lot of Medicare it cuts down on denials to have a fu note before each procedure. And it’s easy money. Seriously would you not stop and pick a hundred dollar bill off the floor

 

[sdnuser001]

I do follow ups after each MBB but offer telemed if they make a big deal about coming in

 

[so55b]

If you have a lot of Medicare it cuts down on denials to have a fu note before each procedure. And it’s easy money. Seriously would you not stop and pick a hundred dollar bill off the floor

I know it is easy money and I have a lot of Medicare patients. Would you be happy to do that if you were a patient and knew this was only for billing purposes? I understand it might be ok if the patient lives 5 minutes away from the clinic and is completely retired with nothing else to do. Some have to be off from their work with a long trip and they have copays for these visits

 

[SSdoc33]

I know it is easy money and I have a lot of Medicare patients. Would you be happy to do that if you were a patient and knew this was only for billing purposes? I understand it might be ok if the patient lives 5 minutes away from the clinic and is completely retired with nothing else to do. Some have to be off from their work with a long trip and they have copays for these visits

you are doing the work

you should get paid for it.

medicare sets up these inane rules. always blame everything on them... b/c it is indeed their fault

 

[GoBeers]

I know it is easy money and I have a lot of Medicare patients. Would you be happy to do that if you were a patient and knew this was only for billing purposes? I understand it might be ok if the patient lives 5 minutes away from the clinic and is completely retired with nothing else to do. Some have to be off from their work with a long trip and they have copays for these visits

dont stress over things you can't control. this leads to burnout.

 

[knoxdoc]

do you do ODI after every procedure as well

No I do not, only pain log scores.

 

[so55b]

you are doing the work

you should get paid for it.

medicare sets up these inane rules. always blame everything on them... b/c it is indeed their fault

I know they set that rule but never get denied with phone call follow-ups which my staff always help me. I just do not see the validity with each follow up visit after mbbs.

 

[Ronin1]

We actually give this handout when we discuss RFA so they are aware of the process

 

[SSdoc33]

We actually give this handout when we discuss RFA so they are aware of the processView attachment 385288

it really sucks that we have to have 6 patient visits/interactions to get an RF done

also, there are some grammatical errors on your hand out. dont know if you care or not. "mediCal" branch block, etc.

 

[specepic]

1 Consult
2 MBB 1
3 phone call to discuss log
4 if + MBB #2 occurs
5 then OV or TH for "RFA discussion", this is a newer process and I really find it helpful for pts (used to be phone call with staff and RFA order from that)
6 RFA
7 f/u in 2-4M

 

[Ducttape]

also, that is an incorrect usage of a semicolon.

and so55b - the follow ups are technically not just for billing purposes. your follow ups have a diagnostic purpose and furthers treatment goals. if you do not have a follow up with the patient, you are technically not diagnosing facet arthropathy as a contributor to their back pain.



if you want to save them money and not take what is available to you, then fine. call the patient and follow specepic's strategy. not sure the office's bottom line would appreciate the lost revenue, since medicine today seems to be all about $$$.

 

[Ronin1]

I apologize for any grammar issues. This is the first time I even looked at this document honestly. My nurses drew it up to help with patient’s questions. They all just accept it
“Sorry insurance requires this”.

 

[sloh]

also, that is an incorrect usage of a semicolon.

and so55b - the follow ups are technically not just for billing purposes. your follow ups have a diagnostic purpose and furthers treatment goals. if you do not have a follow up with the patient, you are technically not diagnosing facet arthropathy as a contributor to their back pain.

But the physician already saw them in clinic no?

 

[Ducttape]

that is not mandatory from insurance stand point.

but i personally insist on at least initial evaluation for my practice.

 

[so55b]

also, that is an incorrect usage of a semicolon.

and so55b - the follow ups are technically not just for billing purposes. your follow ups have a diagnostic purpose and furthers treatment goals. if you do not have a follow up with the patient, you are technically not diagnosing facet arthropathy as a contributor to their back pain.



if you want to save them money and not take what is available to you, then fine. call the patient and follow specepic's strategy. not sure the office's bottom line would appreciate the lost revenue, since medicine today seems to be all about $$$.

Are you serious you really need to see your patients 1-3 days after the 1st and 2nd MBBs for that diagnostic purpose and treatment goal? So you do this for the sake of the patients not for yourself?

I never call my patients after MBBs. Patients call my office/leave a voice mail and my staff sends me messages about pain relief % and I just make an addendum. That is more than enough for insurance approval and never gets denied.

 

[manowar rules]

I do the call after the MBB, I think it’s better in the long game. Sure you can bring them in if you’re desperate for a 99213, but that would annoy a lot of patients and let’s face it, is medically unnecessary. You don’t have to work yourself to the bone for patients, but if your save them some time and aggravation here and there that corporate offices don’t give a **** about, it can build your reputation and referrals.

 

[MD87]

I do the call after the MBB, I think it’s better in the long game. Sure you can bring them in if you’re desperate for a 99213, but that would annoy a lot of patients and let’s face it, is medically unnecessary. You don’t have to work yourself to the bone for patients, but if your save them some time and aggravation here and there that corporate offices don’t give a **** about, it can build your reputation and referrals.

I don’t bring them back into the office either. But if I did, pretty sure could be a 99214.

 

[gaspasser127]

We’ve had a hard time getting patients to call in with their pain diaries

Follow up visits to document % relief are an unnecessary expenditure of healthcare resources (just my opinion)

I had my staff call patients but that ended up being hit or miss.

Now i have patients stick around for 30 min after the injection to document % relief in the recovery area. If >80% i document that in the op note.

Haven’t had any issues getting 2nd MBB or RFA auth.

 

[Dr. Ice]

Everyone is coming back all the time for everything. I didn’t make the rules. People leave work early to get their hair did all the time

 

[Ducttape]

Are you serious you really need to see your patients 1-3 days after the 1st and 2nd MBBs for that diagnostic purpose and treatment goal? So you do this for the sake of the patients not for yourself?

I never call my patients after MBBs. Patients call my office/leave a voice mail and my staff sends me messages about pain relief % and I just make an addendum. That is more than enough for insurance approval and never gets denied.

at the very least, you should communicate with the patient. there is no requirement in the LCD itself.

i see them because i think the information you give them - particularly with the second MBB and then the RFA - is invaluable so they dont think it is a one and done and it didnt work because it only lasted a day.

and its money you are leaving on the table. up to you.



as for your last statement - i take it you dont see any NY WC or Medicaid Option patients.

 

[lobelsteve]

I could see 25% fewer patients every day if all I did was clog my office with appt that could be done over the phone by a nurse.