Medicare eliminates most peripheral nerve blocks

[Agast]

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[Agast]

I’ve already changed occipital nerve blocks to trigger point injections coding, but I have a few patients who get thoracic RFA.

Eliminating genicular nerves and stellate ganglion/trigeminal nerve blocks is throwing a huge grenade at patients

 

[SgtThunderfistMD]

This is just proposed for now, right?

 

[Baron Samedi]

At least we got the Gulf of America

 

[Agast]

This is just proposed for now, right?

There's a reason why a lot of these blocks aren't covered by private insurance - there is not a lot of research done showing therapeutic efficacy. We've just done these injections "since the dawn of time" and enjoyed grandfathered status. Now CMS is trying to save money and this is the lowest hanging fruit. I would be surprised if the procedures survive.

So back to what supposed KOLs could do for us - they could be doing the research trials that help us hold on to the non-device procedures that help our patients.

 

[buddababa]

I’ve already changed occipital nerve blocks to trigger point injections coding, but I have a few patients who get thoracic RFA.

Eliminating genicular nerves and stellate ganglion/trigeminal nerve blocks is throwing a huge grenade at patients

cant use steroid with trigger points, so difficult to get good results "for occipital blocks"

 

[MitchLevi]

ONB are billed as occipitalis TPI by me, and they are extremely effective and I do them frequently.

 

[Malayil]

I sent my e-mail

 

[hyperalgesia]

There's a reason why a lot of these blocks aren't covered by private insurance - there is not a lot of research done showing therapeutic efficacy. We've just done these injections "since the dawn of time" and enjoyed grandfathered status. Now CMS is trying to save money and this is the lowest hanging fruit. I would be surprised if the procedures survive.

So back to what supposed KOLs could do for us - they could be doing the research trials that help us hold on to the non-device procedures that help our patients.

KOLs only exist in the context of expensive devices and kits. Outside of that setting, they simply don't exist. Poof!

 

[hyperalgesia]

This forces docs to offer these for cash.

If people truly get relief and it's worth it, they'll come.

It could end up being a good thing.

 

[buddababa]

ONB are billed as occipitalis TPI by me, and they are extremely effective and I do them frequently.

but you can't use steroid in TPI, so you're getting great effectiveness with just local?

 

[SSdoc33]

At least we got the Gulf of America

Marvelous comment

 

[SSdoc33]

For those in HOPD settings, keep billing the nerve blocks and their CPT codes. It can sometimes take YEARS before the billers catch on. Meanwhile you still get the RVUs bc eff the hospital. Btw, they will never love you back

Is there and alternative (NOS) code that might get paid?

Occipital are the one that come to mind but hip shoulder and knee blocks pre-RF are a big deal. No LFCN blocks. No inguinal blocks.

No bueno

I wonder if there is a loophole where you wouldn’t classify these for ‘chronic pain’. Anesthesiologists will still be doing femoral nerve blocks prior to a TKA, for example

 

[Agast]

The LCD may say there is no therapeutic benefit, but it’s harder to say there is no diagnostic benefit

You could arguably do a diagnostic peripheral nerve block to determine peripheral vs radicular pain generator, plus steroid, unless the LCD specifically addresses the diagnostic component.

The CPT codes will still exist

 

[Baron Samedi]

This forces docs to offer these for cash.

If people truly get relief and it's worth it, they'll come.

It could end up being a good thing.

hyperalgesia when a little old lady with her $1800/mo Social Security check walks through the door...

 

[BobBarker]

great idea. Maybe some dex will accidentally slide into a dx block. Humans do make mistakes after all.

 

[MitchLevi]

but you can't use steroid in TPI, so you're getting great effectiveness with just local?

Of course.

Occipital blocks with 0.5% ropi is a great injection for chronic migraines, occipital headaches, whiplash, etc.

I do a TPI in the traps, cervical paraspinals, greater and lesser ONB.

Takes me no time to do it, and patients get good results from it. Start doing these more often. Need a driver because bilateral ONB can cause dizziness, but extremely rarely.

 

[BobBarker]

And it looks like we can still do ablations. I have a gentleman that comes once a year and I bipolar his cluneal nerves on one side. Comes to visit his daughter and stops in while here. Ohio resident.

 

[painER]

Not so sure about that. Number 13 looks like a catch all for eliminating any peripheral nerve block or denervation.

 

[BobBarker]

Not so sure about that. Number 13 looks like a catch all for eliminating any peripheral nerve block or denervation.

Darn, you are correct. Cash it is.

 

[swamprat]

Dont worry they will still cover percocet!

.. oh wait, write too much of that (bc no one other than the pain doc can write it) and you will be blacklisted by the pharmacy!

 

[SSdoc33]

Of course.

Occipital blocks with 0.5% ropi is a great injection for chronic migraines, occipital headaches, whiplash, etc.

I do a TPI in the traps, cervical paraspinals, greater and lesser ONB.

Takes me no time to do it, and patients get good results from it. Start doing these more often. Need a driver because bilateral ONB can cause dizziness, but extremely rarely.

I do the same thing. A lot

 

[Dr. Ice]

The field is ****ed..feel bad for the youngins in the middle of fellowship or just starting now

Isn’t RF one of the few things we have with decent research, how bout bagging mild and sij fusions instead

 

[nvrsumr]

Gonna be a lot more stim.

 

[Dr. Ice]

Gonna be a lot more stim.

Yeah like a lot more…

 

[bedrock]

Yeah like a lot more…

Gonna be a lot more stim.

Yep, government in action. They’ll eliminate the cheap options so everyone will try to kill a gnat with a bat and stim everyone.

 

[bedrock]

I’ve already changed occipital nerve blocks to trigger point injections coding, but I have a few patients who get thoracic RFA.

Eliminating genicular nerves and stellate ganglion/trigeminal nerve blocks is throwing a huge grenade at patients

It said thoracic nerve. Couldn’t that be intercostal blocks?

Maybe thoracic RFA will still be covered?

I can’t believe the stupidity to stop covering genicular RFA. I already don’t offer those because bad pay, but they make life more bearable for many patients.

My big concern is if Medicare stops covering all those nerve blocks then next year all the commercial payors will stop covering them too.

 

[bedrock]

Does anyone still cover occipital nerve blocks? I though some of the BCBS plans still did ?

 

[hyperalgesia]

The field is ****ed..feel bad for the youngins in the middle of fellowship or just starting now

Isn’t RF one of the few things we have with decent research, how bout bagging mild and sij fusions instead

Even though medial branches of the NRs are technically peripheral nerves, I think they would have been specifically mentioned if they were included in this purge.

 

[hyperalgesia]

I can’t believe the stupidity to stop covering genicular RFA. I already don’t offer those because bad pay, but they make life more bearable for many patients.

I like these too. Better results than lumbar RFA in my patients.

 

[bedrock]

Even though medial branches of the NRs are technically peripheral nerves, I think they would have been specifically mentioned if they were included in this purge.

agree. They are going after the low hanging fruit first.

 

[Agast]

It said thoracic nerve. Couldn’t that be intercostal blocks?

Maybe thoracic RFA will still be covered?

Here’s hoping T_T

 

[Status Sciaticus]

There's a reason why a lot of these blocks aren't covered by private insurance - there is not a lot of research done showing therapeutic efficacy. We've just done these injections "since the dawn of time" and enjoyed grandfathered status. Now CMS is trying to save money and this is the lowest hanging fruit. I would be surprised if the procedures survive.

So back to what supposed KOLs could do for us - they could be doing the research trials that help us hold on to the non-device procedures that help our patients.

Time to start stimming everything. Better get my pointy shoes ready.