New ICD-10 Code for Vertebrogenic Low Back Pain

[drusso]

In recognition of the stratospheric rates of Modic-related back pain ravaging our country, this couldn't come at a better time...

Relievant Medsystems Announces New Vertebrogenic Low Back Pain ICD-10 Diagnosis Code - Relievant

Relievant Medsystems, a privately held medical device company transforming the treatment of Chronic Low Back Pain (CLBP), today announced the Centers for Disease Control and Prevention (CDC) has designated an International Classification of Diseases, Tenth Revision, Clinical Modification...

www.relievant.com

“The CDC’s recognition of vertebrogenic pain as a specific low back pain condition follows decades of research characterizing the role of the basivertebral nerve in transmitting pain signals from damaged vertebral endplates.” “For the first time, clinicians have a unique code to diagnose and report this condition accurately, helping connect the millions of patients suffering from vertebrogenic pain with effective, long-lasting relief following the Intracept Procedure.”

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[lobelsteve]

Excellent lobbying by the BVN moneymen.

 

[Taus]

And just like SI and geniculate rf….. the insurers now have a distinct code to deny as experimental….

 

[myrandom2003]

And just like SI and geniculate rf….. the insurers now have a distinct code to deny as experimental….

The commercials already say that they do not specifically cover basivertebral nerve ablation in guidelines, now there is a code to go with it.

 

[bedrock]

The commercials already say that they do not specifically cover basivertebral nerve ablation in guidelines, now there is a code to go with it.

So what insurances are covering this so far?

I see a patient every so often that may benefit from it, and would refer them out, but not if no insurances cover it.

 

[Tboned]

So what insurances are covering this so far?

I see a patient every so often that may benefit from it, and would refer them out, but not if no insurances cover it.

You should talk to your local rep. Mine has given me a detailed report on this stuff

 

[myrandom2003]

Medicare.

The company has an internal pre-auth dept that does the auth for you and appeals.

 

[bedrock]

You should talk to your local rep. Mine has given me a detailed report on this stuff

Can you give me a general idea of which major insurances cover this as in blue cross vs Cigna vs UHC vs Aetna?

I don’t plan to personally offer the procedure but if for example, blue cross doesn’t cover it, I won’t bother referring patients under that insurance.

 

[RoloTomassi]

I've done all the above but they are case by case basis, typically low probability, long wait, 2-3 appeals (assisted by company)

 

[bedrock]

I've done all the above but they are case by case basis, typically low probability, long wait, 2-3 appeals (assisted by company)

Thanks for the info. Do the Medicare (non advantage) go through without a hassle?

 

[RoloTomassi]

Thanks for the info. Do the Medicare (non advantage) go through without a hassle?

Yes. Keep in mind also that most ASCs can't make it profitable, best done HOPD

 

[Taus]

Yes. Keep in mind also that most ASCs can't make it profitable, best done HOPD

Until that changes…. It will go the way of cooled rf…. HOPD only greatly limits utilization. For now, regardless of efficacy per the studies, the juice ain’t worth the squeeze for going through the hassle on this. Just like intradiscal regenerative, I may refer 1 to 5 of these out per year.

 

[drusso]

Until that changes…. It will go the way of cooled rf…. HOPD only greatly limits utilization. For now, regardless of efficacy per the studies, the juice ain’t worth the squeeze for going through the hassle on this. Just like intradiscal regenerative, I may refer 1 to 5 of these out per year.

In the HOPD the Juice from the Squeeze comes from the vig on the SOS...

 

[Taus]

In the HOPD the Juice from the Squeeze comes from the vig on the SOS...

Yes, I understood, I meant with regards to the pita of getting approval and reimburse adequately to cover costs outside hopd. I also don’t think Medicare patients are the prime contributor to your epidemic of vertebrogenic lbp

 

[drrosenrosen]

My partner does this and I'm looking at training for it. Approvals (handled by the company) take 2-6 months...

 

[bedrock]

Yes, I understood, I meant with regards to the pita of getting approval and reimburse adequately to cover costs outside hopd. I also don’t think Medicare patients are the prime contributor to your epidemic of vertebrogenic lbp

Agree with Medicare point. This is much more likely to help someone in their 40s-50s than a Medicare patient.

Not sure if I’m going to bother referring these out if it’s rarely paid/ 3-6 month auth delay for patient.