New facet LCD as per July 1.....effective August 11

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

Doctodd

Membership Revoked
Removed
15+ Year Member
Joined
Jul 4, 2005
Messages
9,336
Reaction score
3,832
is it already being discussed? Still going through it.....is it only for facet cysts?

LCD - Facet Joint Interventions for Pain Management (L33930)

Following the open comment period, the LCD was revised to allow medial branch blocks (MBBs) for radiofrequency
ablation (RFA) when applicable. The facet cyst aspiration frequency limitation section has been clarified to specify
that the limitation is per individual cyst. A summary and analysis of evidence for the literature that was submitted
during the comment period has been added.
 
Therapeutic blocks are allowed again if can’t do RF.

But I’m sure there will be an initial denial in payment if steroid included in the claim necessitating appeal and more work when it’s easier to eat the $0.50 for the dex. Like how it says they will pay for three levels if there is scoliosis but that third level requires way more work than what it’s worth.
 
Therapeutic blocks are allowed again if can’t do RF.

But I’m sure there will be an initial denial in payment if steroid included in the claim necessitating appeal and more work when it’s easier to eat the $0.50 for the dex. Like how it says they will pay for three levels if there is scoliosis but that third level requires way more work than what it’s worth.
ive never been able to get the third level covered. even after appeal
 
Therapeutic blocks are allowed again if can’t do RF.

But I’m sure there will be an initial denial in payment if steroid included in the claim necessitating appeal and more work when it’s easier to eat the $0.50 for the dex. Like how it says they will pay for three levels if there is scoliosis but that third level requires way more work than what it’s worth.
Eat the cost of dex? Surely you mean just doing MBB without steroids.
 
What exactly do they mean by, " Intraarticular (IA) facet block(s) are considered medically reasonable and necessary as a diagnostic test only if MBB cannot be performed due to specific documented anatomic restrictions or there is an indication to proceed with therapeutic intraarticular injections"?

What anatomic restrictions allow one to do an intra-articular facet instead of a MBB?
 
What exactly do they mean by, " Intraarticular (IA) facet block(s) are considered medically reasonable and necessary as a diagnostic test only if MBB cannot be performed due to specific documented anatomic restrictions or there is an indication to proceed with therapeutic intraarticular injections"?

What anatomic restrictions allow one to do an intra-articular facet instead of a MBB?

You’re thinking too hard. It seems like it doesn’t make sense because it doesn’t make sense.
 
What exactly do they mean by, " Intraarticular (IA) facet block(s) are considered medically reasonable and necessary as a diagnostic test only if MBB cannot be performed due to specific documented anatomic restrictions or there is an indication to proceed with therapeutic intraarticular injections"?

What anatomic restrictions allow one to do an intra-articular facet instead of a MBB?
How about a fat IPG battery in the way when you oblique
 
What exactly do they mean by, " Intraarticular (IA) facet block(s) are considered medically reasonable and necessary as a diagnostic test only if MBB cannot be performed due to specific documented anatomic restrictions or there is an indication to proceed with therapeutic intraarticular injections"?

What anatomic restrictions allow one to do an intra-articular facet instead of a MBB?
Synovial cyst? Bone spur?
 
What exactly do they mean by, " Intraarticular (IA) facet block(s) are considered medically reasonable and necessary as a diagnostic test only if MBB cannot be performed due to specific documented anatomic restrictions or there is an indication to proceed with therapeutic intraarticular injections"?

What anatomic restrictions allow one to do an intra-articular facet instead of a MBB?

It is reasonable to proceed with therapeutic intraarticular facet injections after two diagnostic medial branch blocks IF there is a medical contraindication for radiofrequency ablation, such as an implanted pacemaker/AICD. The comment you are quoting basically eliminates the no-steroid medial branch block x2 prior to lumbar facet steroid injections requirement if you are just going to do intraarticular facet injections long term anyway because you medically cannot do an ablation.
 
Top