Medicare eliminates most peripheral nerve blocks

[PinchandBurn]

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I sent my e-mail

I sent mine too!!


We should all be doing this and telling our staff too. It takes 5min. ChatGPT can make it. Then email it on. Talk is cheap.

 

[painisfear]

we all need to email our local LCDs the comments. ASIPP has contact information and templates.

If you’re not an ASIPP member you should join. You can also donate to the ASIPP PAC. They are the only group I see actually fighting for us.

I don’t see AMA, ASRA, ASPN or any of the other groups doing this.

Does anyone know who actually makes these suggestions? Which doctors or groups or societies? Let’s better understand who they are.

Downcoding something to a trigger point may still give a patient access but 1) it’s fraud and 2) you are getting paid less for something.

I think it’s sad to say but cash is the only way forward if these coverage recommendations stick.

 

[hyperalgesia]

we all need to email our local LCDs the comments. ASIPP has contact information and templates.

If you’re not an ASIPP member you should join. You can also donate to the ASIPP PAC. They are the only group I see actually fighting for us.

I don’t see AMA, ASRA, ASPN or any of the other groups doing this.

Does anyone know who actually makes these suggestions? Which doctors or groups or societies? Let’s better understand who they are.

Downcoding something to a trigger point may still give a patient access but 1) it’s fraud and 2) you are getting paid less for something.

I think it’s sad to say but cash is the only way forward if these coverage recommendations stick.

The AMA RUC committee decides the Medicare fee schedule.

In exchange, Medicare pays yearly licensing fees to AMA for their copyrighted CPT codes.

That's what we're dealing with.

 

[painisfear]

The AMA RUC committee decides the Medicare fee schedule.

Yeah I was wondering if the fee schedule people are the same ones who decide what’s covered at all.

 

[Agast]

So on the first read, I missed that Novitas is excluded from the LCD updates. Anyone know why? The only thing interesting about that region is it includes Washington DC, and I think federal BCBS follows Medicare guidelines

 

[BobBarker]

Novitas remains the best of the bunch. Thank god.

 

[drusso]

KOL's convened at an undisclosed location. This is not going to happen.

 

[giddyup]

Has anyone used the Stryker system? I’ve only done 5 cases so far but pretty happy with the rep and prior auth support from BoSci

I tried it in my office on a demo model. I liked the access equipment better, slightly less complicated. I have heard (from Intracept reps so caveat there) that their metal stylet doesn't curve well so hard to hit the target, it tends to go too anterior.

 

[Taus]

I tried it in my office on a demo model. I liked the access equipment better, slightly less complicated. I have heard (from Intracept reps so caveat there) that their metal stylet doesn't curve well so hard to hit the target, it tends to go too anterior.

Doing a few cases next month with Stryker to test it out.

My only concern is lack of straight stylet at S1 and some wide L5 vert bodies when need to extend the channel w J maxed, before it turns back on self. Rep said the Stryker curve gets “de-articulated” and then acts as a straight. We’ll see.

 

[CleanUp]

Is the price for the Stryker kit that much lower than Boston’s kit?

 

[DoYouEvenLiftBro]

Cool, I'll go straight to Sprint PNS, and skip the nerve block. Thanks MCR!

this was my same thought

Thoracic pain code —> 2 lead SPR

Faster than the ablation but the clinic billing will lose out (we’re so back logged it probably wouldn’t matter booking out into January now 😬)

 

[DoYouEvenLiftBro]

Ironically yesterday during Intracept 4 level case kept getting high impedance likely from blood and needed to take out the probe every minute for one level… the Stryker system in theory with their saline wouldn’t have had that issue and I could have started burning at the other levels while that happened due to multiple probes

I’m also curious if the small gauge will help with S1 access with some of the narrow crests

I just did the training Saturday, they said the curve is steel so it won’t bend…

I liked the system overall, it drives just like their kypho jamshedi, had same question about the bigger pts question and needing the Intracept #3, they said their curve tool is longer.. not sure that’s accurate

 

[giddyup]

Ironically yesterday during Intracept 4 level case kept getting high impedance likely from blood and needed to take out the probe every minute for one level… the Stryker system in theory with their saline wouldn’t have had that issue and I could have started burning at the other levels while that happened due to multiple probes

I’m also curious if the small gauge will help with S1 access with some of the narrow crests

I just did the training Saturday, they said the curve is steel so it won’t bend…

I liked the system overall, it drives just like their kypho jamshedi, had same question about the bigger pts question and needing the Intracept #3, they said their curve tool is longer.. not sure that’s accurate

Not sure if this is true as this is from the Intracept rep, but they said the Stryker system you need to do all burns at one time, as in you start them all together, which somewhat defeats the purpose.

 

[Crybaby]

I tried it in my office on a demo model. I liked the access equipment better, slightly less complicated. I have heard (from Intracept reps so caveat there) that their metal stylet doesn't curve well so hard to hit the target, it tends to go too anterior.

It is similar to their omni curve in the kypho kits, correct?
I was curious to see if it would make it through hard bone, what do you think?

 

[giddyup]

It is similar to their omni curve in the kypho kits, correct?
I was curious to see if it would make it through hard bone, what do you think?

i have never done a kypho so couldnt say - this was my first exposure to this type of equipment from them

 

[mdo1738]

Does stryker have the same 5-case line up training requirement to use their product?

Was told no requirement on any cases being lined up by my Stryker rep.

 

[Agast]

Was told no requirement on any cases being lined up by my Stryker rep.

Well, there goes Intracept. Another wasted Boston Scientific investment.

 

[FatKid]

Well, there goes Intracept. Another wasted Boston Scientific investment.

Yup.

Government wants everyone on opioids, despite what they publicly say.

 

[giddyup]

Well, there goes Intracept. Another wasted Boston Scientific investment.

what happened? is this not covered anymore like in the last 24 hours?

 

[DoYouEvenLiftBro]

what happened? is this not covered anymore like in the last 24 hours?

He’s saying cus ppl will just use the Stryker one

 

[DoYouEvenLiftBro]

what happened? is this not covered anymore like in the last 24 hours?

He’s saying cus ppl will just use Stryker

Not sure if this is true as this is from the Intracept rep, but they said the Stryker system you need to do all burns at one time, as in you start them all together, which somewhat defeats the purpose.

you do not need to do all at once

It is similar to their omni curve in the kypho kits, correct?
I was curious to see if it would make it through hard bone, what do you think?

its similar to Omni yeah, also to their ablation kit

 

[bedrock]

He’s saying cus ppl will just use the Stryker one

I’m going to stick with Boston unless Stryker drops their price at least 20% less than Boston. Stryker didn’t pay for the original studies and treatment development. They don’t deserve to ask essentially the same price for their kit.

 

[Welcome123]

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

clinical judgment does not correlate with reimbursement. The policy says no, so regardless of reason good or bad they do not have to pay.

 

[Welcome123]

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.

Yep

 

[Welcome123]

Yep

This actually has happened with anthem bcbs this year

 

[SC Tian]

Did the CMS eventually finalize the policy for peripheral nerve block? thanks