medicare guidelines for RF require FACET injection??

[NEPain]

Yesterday, our billing people sent us new guidelines from Medicare for RF of medial branches.

Among other serious errors was the following paragraph. Did anyone else receive a similar notice? I use MBB's and certainly don't expect weeks of relief from them!


"Appropriate diagnostic facet blocks have been performed (at least 2 sets, double comparative) and that the patient obtained greater than 50% relief for a minimum of 6 weeks with a continued ability to perform previously painful maneuvers"

---

Members don't see this ad.

 

[PMR 4 MSK]

National Medicare, or just your local administrator?

 

[SSdoc33]

effing ridiculous.

im sure that means an intra-articular facet injection (with steroid? without?), but that language is ambiguous, and im sure can be used to deny approval of RF.

 

[NEPain]

Yes, it's absurd. I assume it's our local administrator as I doubt National Medicare would make such a faux pas. I've asked our billing people and will let you know if it's just local.

I suppose I can find out how to contact our local Medicare to discuss...Any suggestions?

 

[NEPain]

I asked for the original document from our billing people and it turns out that they misinterpreted it. No changes from status quo. Sorry to raise alarm...