New Cat 1 Code for Dorsal SIJ Fusion

Started by drusso
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drusso

drusso

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Now, more than ever, we need options for patients suffering from disabling and incapacitating SIJ pain. Office-based SIJ ablations are experimental and HOPD-based fusions are fool-proof.


www.prnewswire.com

AMA Announces Category 1 Billing Code for Posterior SI Joint Fusion

/PRNewswire/ -- The American Medical Association (AMA) has announced a new Category 1 billing code specifically for posterior SI joint fusion, including...
www.prnewswire.com www.prnewswire.com
 
drusso said:
Now, more than ever, we need options for patients suffering from disabling and incapacitating SIJ pain. Office-based SIJ ablations are experimental and HOPD-based fusions are fool-proof.


www.prnewswire.com

AMA Announces Category 1 Billing Code for Posterior SI Joint Fusion

/PRNewswire/ -- The American Medical Association (AMA) has announced a new Category 1 billing code specifically for posterior SI joint fusion, including...
www.prnewswire.com www.prnewswire.com
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SIJ pain is never disabling nor incapacitating. I will make exceptions for Fx across the joint or AS/cancer.
 
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lobelsteve said:
Misdiagnosis, or intentional to allow for lucrative interventional care?
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Lobel it really doesn't pay much from professional fee standpoint. I guess if you on ur ASC but when i do posterior SI arthrodesis I'm getting between 500-750/800 depending payor. Far from a homerun. Much rather do in office stim or kypho or MM lol - ancedotally I do feel this works well in the right patient - must have successful pain relief for duration of anesthestic after SI joint injection.
 
What percentage of patients do we see actual have SIJ pain?

What percentage of patients do we see that have SIJ pain that fail PT/topical nsaids?

What percentage of those patients fail SIJ inj? Then fail SIJ RF?

1 in a thousand of my patients fit this category. Not enough to determine if a next step is needed or if it would work.
 
lobelsteve said:
What percentage of patients do we see actual have SIJ pain?

What percentage of patients do we see that have SIJ pain that fail PT/topical nsaids?

What percentage of those patients fail SIJ inj? Then fail SIJ RF?

1 in a thousand of my patients fit this category. Not enough to determine if a next step is needed or if it would work.
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Do you really only have that few that don’t get SI relief with that algorithm?
 
I know lot of folks don’t really believe it’s SIJ…. But it’s top 10 diagnosis in my practice. I’m not so confident about cluneal and other exotica and I don’t fuse. But lateral branch rfa has done wonders for my patients. Bipolar 18G venom 5 needles based on the Stout paper and Burnham papers that came out 3-6 years ago in pain medicine journal.
 
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SIJ is not an uncommon diagnosis in my practice. I rarely see it debilitating, especially in the motivated patient doing PT. A good amount respond to IA or RFTC and if that's not enough I stop and say they have to learn to manage it - it's not keeping any of my patients from working who want to.
 
swamprat said:
How so? If intra-articular and 1-2 cc 0.5% bupivacaine injected into joint and they have pain relief where is the pain generator?
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I find SIJ pain far more complicated than that.

Pain is an emotional experience by definition, and the idea an anesthetic test dose means anything of value is way too simple IMO.

These same pts...You chase that local with a CSI or no?
 
MitchLevi said:
I find SIJ pain far more complicated than that.

Pain is an emotional experience by definition, and the idea an anesthetic test dose means anything of value is way too simple IMO.

These same pts...You chase that local with a CSI or no?
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I'm sorry CSI?

And yes all pain there is a supratentorial component for sure I'm just saying anecdotally it has been really successful for my patients
 
I'm open minded to SI fusion as a last resort, but rarely see candidates. Again, because most SI area pain is radic/facet/disc/endplate, and if actually SI, responds to steroid/PRP/RFA.

I think intraarticular anesthetic injection with minimal skin local has diagnostic value. I do differential intraarticular hip blocks. Not that different from MBB either
 
I have a couple lumbar fusion patients who get 3-6m relief from PRP carpet bombing of SIJ and ligaments and a couple other areas including epidurally. And yes they have failed everything else. For $500 it’s worth it to them.
 
Doctodd said:
I have a couple lumbar fusion patients who get 3-6m relief from PRP carpet bombing of SIJ and ligaments and a couple other areas including epidurally. And yes they have failed everything else. For $500 it’s worth it to them.
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$500 is a great price for a PRP injection - is that how much you’re charging total?
 
Doctodd said:
I have a couple lumbar fusion patients who get 3-6m relief from PRP carpet bombing of SIJ and ligaments and a couple other areas including epidurally. And yes they have failed everything else. For $500 it’s worth it to them.
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Can you tell me what "company" or whatever you use for PRP? I'm interested in this but never was approached by any reps or anything. 500 isnt bad I bet some of my patients who failed everyhing else would possibly be OK doing this.
 
I don’t use kits anymore, but Emcyte was who I started with….yes $500 for established patients
 
I've had PRP for my SIJ twice. First injection gave me 6 months of relief. Second injection involved more of a "carpet bombing" technique and has given me 2.5 years of relief. It hasn't eliminated my underlying dysfunction, but has certainly allowed me to be more physically active than I was 5 years ago.
 
swamprat said:
Lobel it really doesn't pay much from professional fee standpoint. I guess if you on ur ASC but when i do posterior SI arthrodesis I'm getting between 500-750/800 depending payor. Far from a homerun. Much rather do in office stim or kypho or MM lol - ancedotally I do feel this works well in the right patient - must have successful pain relief for duration of anesthestic after SI joint injection.
Click to expand...

These procedures' purpose/pricing model is to drive reimbursement to the facility. The vig on the SOS is to the facility, not the doctor. The best scenario is to be on BOTH sides of the deal--the menial pro fee and the juicy facility. That's how the magic happens.
 
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MitchLevi said:
I find SIJ pain far more complicated than that.

Pain is an emotional experience by definition, and the idea an anesthetic test dose means anything of value is way too simple IMO.

These same pts...You chase that local with a CSI or no?
Click to expand...
So you don’t do medial branch blocks?
 
Aren’t there certain posterior SI fusions that are still covered? (Cornel loc, etc). Also, what’s preventing one from doing lateral fusion with Rialto (medtronic).

Just wondering as I am trying to navigate around this
 
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MitchLevi said:
I've seen SCS for SIJ pain. Clear SIJ pain misdiagnosed by outside pain physicians.
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In these people who clearly do well with SIJ diagnostic injection but fail RFA, no centrifuge around or no relief with PRP, what is the argument against trying dorsal column stim? If it has some data for failed back, why wouldn't chronic SIJ pain respond also? Would we all honestly even think about a fusion in that case over something we have more experience with as a field? Just food for thought.
 
Norepi said:
In these people who clearly do well with SIJ diagnostic injection but fail RFA, no centrifuge around or no relief with PRP, what is the argument against trying dorsal column stim? If it has some data for failed back, why wouldn't chronic SIJ pain respond also? Would we all honestly even think about a fusion in that case over something we have more experience with as a field? Just food for thought.
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No data for OA of facets, hips, knees... What makes you think it'd work for OA of SIJ?
 
Norepi said:
In these people who clearly do well with SIJ diagnostic injection but fail RFA, no centrifuge around or no relief with PRP, what is the argument against trying dorsal column stim? If it has some data for failed back, why wouldn't chronic SIJ pain respond also? Would we all honestly even think about a fusion in that case over something we have more experience with as a field? Just food for thought.
Click to expand...
Sorry, there's no food for thought here.

SI laxity or sclerosis of the joint. OA...

By the very MOA of SCS, there is no role for stimulation.

The thought process you’re detailing is what leads to overuse and subsequent payer scrutiny. Eventually the treatment goes away.
 
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