MBB follow ups

[callmeanesthesia]

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Do you do your MBB follow up appointments by phone, or in person? I’d like to be able to free up that time in clinic since I do a lot of MBB/RF. In my area Medicare and most private insurers require 2 MBBs, and Medicaid requires 2 and you have to submit a pain diary and document the first one worked before getting the second authorized, so you need a visit in between the MBBs. I don’t have a mid-level to do it for me. My dilemma is that I want to free up the space of the quick “yep, worked great - order the RF” follow ups for new patients but I don’t want to be doing a bunch of work over the phone figuring out what to do with the failed blocks without getting paid. Thinking of having an MA place follow up calls after MBBs - those that worked well get an order placed for the RF, those that didn’t get a follow up appointment.

 

[deleted131481]

I'm in an academic practice where many prefer facet injections. I do primarily mbb/rf and have an MA call the patient the next day then schedule 2nd mbb/RF or followup. Patient's get a pain diary and explanation in discharge instructions but of course is never read. Because I've had denials for documenting "excellent" relief, I now tell patients we only proceed if you have 80%+ relief through the next day. I ask the MA to specifically ask "Did you have at least 80% pain relief in (location of pain)"? It should be less than 5 min a call.

 

[cowboydoc]

Ditto. They get a packet with the explanation of the process from MBB, phone f/u, MBB #2, phone f/u, RFA; pain diary, etc. I created a macro for MAs to call the patient and document results in chart, so it's consistent. If positive, the process rolls. If negative, or the patient says it "didn't work" because it "only lasted 4 hours," and my staff can't get it handled over the phone, we do a f/u visit.

 

[SSdoc33]

i do all the office f/u myself. i walk in, ask if the shot worked, then walk out and book the next shot. takes 2 minutes and the history and exam are templated. easiest patients i have, and they take next to zero office time if you tee it up appropriately in their initial visit

id recommend increasing your efficiency on the process you have in place. you dont want the RFs to slip through your practice b/c they pay well AND the work well. if you get MAs/office staff involved, then may screw it up

 

[Ducttape]

one of my local Medicaid insurances are insisting on a physical exam in between the MBBs, so the follow up phone call idea for that insurance wouldn't work.

you could set aside a time block for quick postprocedure follow ups, with the caveat for the patient that it is a necessary part of the procedure, and set aside say <10 min per patient during that time period and do level 2 visits to see if they had 80% reduction in pain.... its a balance between how much work you want to put in to it.

I understand that billing for phone encounters through Medicare keep getting bandied around.

 

[callmeanesthesia]

i do all the office f/u myself. i walk in, ask if the shot worked, then walk out and book the next shot. takes 2 minutes and the history and exam are templated. easiest patients i have, and they take next to zero office time if you tee it up appropriately in their initial visit

id recommend increasing your efficiency on the process you have in place. you dont want the RFs to slip through your practice b/c they pay well AND the work well. if you get MAs/office staff involved, then may screw it up

I agree they are a quick easy visit, but they still take up a follow up slot on my schedule. I also agree there is the potential for mistakes by phone though. I do some follow ups by phone for patients who live hours away, and I can’t seem to get it through to my MA that I need % pain relief and duration of relief documented. I’d need to give him a written script I think.

 

[callmeanesthesia]

one of my local Medicaid insurances are insisting on a physical exam in between the MBBs, so the follow up phone call idea for that insurance wouldn't work.

you could set aside a time block for quick postprocedure follow ups, with the caveat for the patient that it is a necessary part of the procedure, and set aside say <10 min per patient during that time period and do level 2 visits to see if they had 80% reduction in pain.... its a balance between how much work you want to put in to it.

I understand that billing for phone encounters through Medicare keep getting bandied around.

I looked into the new telemedicine codes - they pay so little it’s barely worth the effort. Also, with the ones I looked into you can’t bill for them if they are the direct result of a previous visit within a week, or result in a visit. You can only bill for office visits via telemedicine (using office visit 9921x codes) if it’s audio and video, and coming from an authorized originating location.

 

[SSdoc33]

I agree they are a quick easy visit, but they still take up a follow up slot on my schedule. I also agree there is the potential for mistakes by phone though. I do some follow ups by phone for patients who live hours away, and I can’t seem to get it through to my MA that I need % pain relief and duration of relief documented. I’d need to give him a written script I think.

so double-book the mbb f/u slots. im sure you can figure out the software intricacies of a a schedule template.

also, these should be level 4 or at least level 3 f/u. dont leave money on the table. ducttape probably has a guilt trip when he goes over 55 on the highway, but some of us are a little more comfortable pushing the boundaries......

 

[paindoc007]

Level 4 for a 30 second mbb followup??
“ Did it Work? Great, let’s proceed with second diagnostic block. “

Come on dude

 

[SSdoc33]

Level 4 for a 30 second mbb followup??
“ Did it Work? Great, let’s proceed with second diagnostic block. “

Come on dude

risks, benefits, alternatives, full exam, details on length of pain relief, change in function after the shot, discussions on possible post-RF neuritis.

there's enough there.

only time i dont bill a level 4 is when a patient comes back after a shot, have no pain, and i lterally dont offer any additional treatment.

i do not feel bad AT ALL about working CMS' arbitrary and ambiguous billing system to my advantage