MBB results

[giddyup]

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How do y’all get your results from MBB? At my last practice we just called them the next day and said “what % relief did you get.” At my new practice we give them a sheet and it has time points 0/2/4/6 hours on it and also left side right side and also circle what % relief you got 0/20/40/60/80/100. Then they call the next day to report results. To me, this is overly complex. My partner called me yesterday and told me he had just gotten an RFA denial bc all time points weren’t 80% and he used Marcaine. Both of my practices have been private practices. Not sure if the new practice is more complex bc one of my partners does his RFA at a local hospital and their requirements are different?

 

[RoloTomassi]

Did pt have >80% pain relief for the duration of the anesthetic? Yes/no

Did pt have functional improvement? Yes/no. Describe.

 

[Dr. Ice]

Everyone comes back in all the time and documented face to face relief tied to a visit. It’s stupid. It’s never been different for me in 3 different settings

 

[BobBarker]

I do telemeds in between. 90% of patients don’t understand medial branch blocks no matter how well you explain them and give them an educational handout.


The way you are doing it now is a recipe to never do an rf again.

My opening question is “did the injection help you for a period of time the day of the injection?” Most people can answer that.

 

[Dr. Ice]

I just tell them to start getting radicular pain so I can do an epidural lol

 

[SSdoc33]

Did the shot help the day of the shot? Yes? Then you get an RF. Make up any numbers you want. Everyone can ‘walk better’ after the shot. I also like this phrase:

‘Pt has competed a full course of PTand performs a good home exercise program within the last 6 months’. You are not technically lying if the pt hasn’t done PT for this problem recently.

Also, remind me how PT will help with facet OA?

 

[callmeanesthesia]

Hour by hour sheet that goes home with them, along with activities they did. Handout on the back of that tells patients what to expect, we verbally tell them at office visit, when scheduling, and then while doing consent that it will last a few hours only. Still have a few say it didn’t help because it wore off the next day, or even cross out the times on the sheet and write dates so they can use it to track for a whole week….

We do telehealth or in office f/u to go over results.

 

[geauxg8rs]

You have to play the stupid game that we didn’t start. If the limit is 80 percent, then it is-

“The insurance company will not allow me to do the Longer lasting RFA unless you say you got 80 percent relief with this test injection. So my question is, “do you think you got at least 80 percent relief from the TEST injections.””

I also explain again before i ask, that these are tests, they do not last long. No matter how many times you explain it you get the “yeah it was great for a day, i had no pain, but it came right back. I don’t want to keep doing that kind of injection.”

This isn’t a double blind placebo controlled study. It ceased being scientific when insurance got involved. It’s a roadblock. Make sure the patient knows what the game rules are before you start playing the game.

 

[Taus]

I have tried several methods. Ideally, I would prefer to have a TeleMed the following day… I just do not have room on my schedule.

At this point: my MA calls patient the following day to ask % relief immediately after and knows to convert it to greater than 80% or not. Ie if whatever they say translates to little to no relief, then it’s under 80%. If their answer translates to more than that, and they’d be happy w that outcome on rfa, then it is greater than 80%. my MA knows never to document something such as 60, 70, 75% etc if the patient was happy with how they felt for duration local. I’m not denying Grandma an Rfa because she only got “75%” relief

A template is then inserted in their chart under phone note with indication for repeat MBB or rfa. Greater than 80% relief for the duration of local aesthetic, resolved pain on extension/rotation, improved function with ADLS X and Y, ODI reduction of 20 points for the duration of local aesthetic.

Ask for stupid things in your LCD criteria… Get stupid templates in the chart…


If they had little to no benefit from the mbb, they get scheduled for a follow up to discuss possible options.

I tried more detailed pain diaries…. Takes time to explain, usually don’t fill it out correctly, don’t get it back to us… gave up on that years ago

 

[SSdoc33]

I have tried several methods. Ideally, I would prefer to have a TeleMed the following day… I just do not have room on my schedule.

At this point: my MA calls patient the following day to ask % relief immediately after and knows to convert it to greater than 80% or not. Ie if whatever they say translates to little to no relief, then it’s under 80%. If their answer translates to more than that, and they’d be happy w that outcome on rfa, then it is greater than 80%. my MA knows never to document something such as 60, 70, 75% etc if the patient was happy with how they felt for duration local. I’m not denying Grandma an Rfa because she only got “75%” relief

A template is then inserted in their chart under phone note with indication for repeat MBB or rfa. Greater than 80% relief for the duration of local aesthetic, resolved pain on extension/rotation, improved function with ADLS X and Y, ODI reduction of 20 points for the duration of local aesthetic.

Ask for stupid things in your LCD criteria… Get stupid templates in the chart…


If they had little to no benefit from the mbb, they get scheduled for a follow up to discuss possible options.

I tried more detailed pain diaries…. Takes time to explain, usually don’t fill it out correctly, don’t get it back to us… gave up on that years ago

You are flushing money down the toilet. Mbb f/u visits are the quickest and best paying thing we do.

A vigorous RF practice is the best way to cash in long term. These are yearly RFs many times

Play the long game

 

[BoardingDoc]

How do y’all get your results from MBB? At my last practice we just called them the next day and said “what % relief did you get.” At my new practice we give them a sheet and it has time points 0/2/4/6 hours on it and also left side right side and also circle what % relief you got 0/20/40/60/80/100. Then they call the next day to report results. To me, this is overly complex. My partner called me yesterday and told me he had just gotten an RFA denial bc all time points weren’t 80% and he used Marcaine. Both of my practices have been private practices. Not sure if the new practice is more complex bc one of my partners does his RFA at a local hospital and their requirements are different?

Everyone comes back for a 60 second follow-up visit within a week to check the box and do a quick 99213

 

[Taus]

You are flushing money down the toilet. Mbb f/u visits are the quickest and best paying thing we do.

A vigorous RF practice is the best way to cash in long term. These are yearly RFs many times

Play the long game

I don’t disagree with you… I just do not have time in my day for that. I’m booked out like six weeks for consults, routinely add on urgent consults, work through lunch, etc. even if it was just another half hour of work to do a few MBB follow ups, document, etc.… I’d rather be out of work 30 minutes earlier. I would also much rather add on another kyphoplasty consult (3-5/week) then 3-5 mbb fw.

 

[callmeanesthesia]

I don’t disagree with you… I just do not have time in my day for that. I’m booked out like six weeks for consults, routinely add on urgent consults, work through lunch, etc. even if it was just another half hour of work to do a few MBB follow ups, document, etc.… I’d rather be out of work 30 minutes earlier. I would also much rather add on another kyphoplasty consult (3-5/week) then 3-5 mbb fw.

God damn. At 3-5 kyphos a week, yeah, you’re not gonna miss a few 99213s…
Have you considered getting a mid-level though? MBB follow ups are great for filling their schedules.

 

[Taus]

God damn. At 3-5 kyphos a week, yeah, you’re not gonna miss a few 99213s…
Have you considered getting a mid-level though? MBB follow ups are great for filling their schedules

3-5 Kypho consults…. Not all will end up needing or wanting it. I do kyphoplasty/week.
Yes, I have thought about a mid-level, I could certainly use one

 

[BobBarker]

I don’t disagree with you… I just do not have time in my day for that. I’m booked out like six weeks for consults, routinely add on urgent consults, work through lunch, etc. even if it was just another half hour of work to do a few MBB follow ups, document, etc.… I’d rather be out of work 30 minutes earlier. I would also much rather add on another kyphoplasty consult (3-5/week) then 3-5 mbb fw.

You don’t have time to make $100 in 3 minutes? Please reconsider.

 

[Taus]

You don’t have time to make $100 in 3 minutes? Please reconsider.

Definitely true for a positive mbb. Negative mbb visits, however, can be awful as they frequently will have no good options left.

 

[BobBarker]

“Well, that is why we do the test blocks. We have a few other options but they are more invasive. Let’s discuss them in person so I can show you on the spine model what else we can do.”