New Nationwide Policy on Facet Joint Interventions

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emd123

emd123

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This is clear as mud

The final LCD, which will be a national one, will be as follows:

  1. Two (2) diagnostic blocks with positive results of 80% or more with 2 weeks apart between the procedures.
  2. Therapeutic facet joint procedures: After the diagnosis of facet joint pain with two (2) diagnostic blocks, subsequent therapeutic facet joint procedures may be provided with at least 50% pain relief or at least 3 months from the prior therapeutic procedure, or at least 50% consistent improvement in the ability to perform previously painful movements and ADLs as compared to baseline measurement using the same scale.
    • However, it is required that the patient is not a candidate for radiofrequency ablation (such as established spinal pseudarthrosis, implanted electrical device). These indications may not be limited. They may depend on each patient and shared-decision makin
    • Diagnostic Intraarticular facet joint injections may be performed prior to therapeutic intraarticular injections.
    • Frequency limitations is for each covered spinal region. No more than 4 therapeutic facet joint sessions will be reimbursed for rolling 12 months.
  1. Facet joint denervation: There is no significant change in this. Limited to two (2) radiofrequency sessions per region with documentation of 50% improvement of pain or function for 6 months.
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What is exactly is the difference between a therapeutic and a diagnostic facet joint procedure? It sounds like you would do 2 local-only facet joint injections in order to do 1 with steroid? That sounds like a giant waste of time.
 
g-damn asipp and their "therapeutic medial branch blocks"

i dont know if this will even have any bearing on how most of us practice
 
So now no IA facets without mbb x2 first, need to wait 2 weeks bw mbb, and now no rfa without 2 blocks on my old Medicare patients.... really sucks for my elderly patients. So now I’m gonna have to make grandma wait like 2 months and go through at least 3 procedures to get any relief
 
Looks like 3 level medial branch blocks and RFA's are gone now, too. Unless "extreme circumstances' and appealed.
 
Who is doin more than 4 lumbar fsi’s per year? Is this really a problem. And if a patient has arthritis in 5 joints you can now only treat two.. this guaranteed not to get good pain relief. Way to go dinguses. Don’t worry though your option for 150k spinal fusion revision is still there.
 
thecentral09 said:
Why diagnostic blocks 2 weeks apart?
Click to expand...
I just read about this my my region's LCD which explains it that "according to Manchikanti et al" diagnostic medial branch blocks 'can last 11 days,' therefore must wait two weeks between medial branch blocks to avoid 'false positives.'

Most MBBs don't last much longer than the local anesthetic duration of action. This is just going to waste everyone's time and drag the whole process out.
 
oh balls. I just looked up the LCD for my area too.....2 wk wait between mbb's?! only 2 RFA per spinal segment per rolling 12 months! so if i do a bilateral in 2 sessions, im hosed for the remainder of the year in that segment of the spine. this sucks. anyway to fight this since it is already a finalized LCD?
 
manchikanti's literature was published exclusively so he could bill mbbs to ASCs and do them every 2 months forever b/c he produced a paper saying that they can be therapeutic. it is really disappointing to see policy based on flawed literature, rather than on the rock-solid stuff bogduk et al have produced
 
Taus said:
So now no IA facets without mbb x2 first, need to wait 2 weeks bw mbb, and now no rfa without 2 blocks on my old Medicare patients.... really sucks for my elderly patients. So now I’m gonna have to make grandma wait like 2 months and go through at least 3 procedures to get any relief
Click to expand...

It’s not going to happen. Grandma is going to give up first because you don’t know what you’re doing. And then she’s going to have spine surgery or get on pills.
 
emd123 said:
Just stumbled upon this. New national facet policy?


New Nationwide Policy on Facet Joint Interventions! - American Society of Interventional Pain Physicians

Interventional pain management techniques in general, facet joint interventions, and epidural interventions in particular, have been in the news for the past year. There have been 2 reports from the … New Nationwide Policy on Facet Joint Interventions! Read More »
asipp.org asipp.org
Click to expand...
that looks like it was posted in 2020
 
I’m already seeing patients who I did both sides on different dates requesting repeat RFA and I can’t do them because they can only get “2 sessions per region per year”.
 
As physicians we can just see more patients and do procedures on them. This really sucks most for the patients. But as noted in the decision it won’t affect patient care lol. I will direct the patients who are denied to the decision and tell them to complain to their Congress pronoun.
 
It goes into effect end of April. Restriction on 2 ablations per facet region per year has been in effect for years for me. Also restriction of 5 facet procedures per year
 
SSdoc33 said:
manchikanti's literature was published exclusively so he could bill mbbs to ASCs and do them every 2 months forever b/c he produced a paper saying that they can be therapeutic. it is really disappointing to see policy based on flawed literature, rather than on the rock-solid stuff bogduk et al have produced
Click to expand...

Why don't you try to step and change things?
 
drusso said:
Why don't you try to step and change things?
Click to expand...
Who says I haven't? You have no idea what I have and haven't done.

9 other people commenting on this thread, yet i dont see any you trying to encourage (provoke) them.
 
After reading it closer, it appears IA therapeutic facet injections will be phased out. The only way they get done is if there is a documented reason that they cannot have RF.
 
spondy14 said:
After reading it closer, it appears IA therapeutic facet injections will be phased out. The only way they get done is if there is a documented reason that they cannot have RF.
Click to expand...

You can do them if there is an anatomical or medical contraindication to MBB. Which doesn’t exist as far as I can brainstorm.
 
Is anyone doing lumbar medial branch peripheral stimulation with sprint or other companies? Interested to hear if people are able to get this approved or are doing this?
 
spondy14 said:
After reading it closer, it appears IA therapeutic facet injections will be phased out. The only way they get done is if there is a documented reason that they cannot have RF.
Click to expand...

If I’m reading this correctly, this only applies to Medicare patients? If so then not a big deal as I generally go straight to RFA on Medicare patients anyway.

I only start with IA facets on middle aged patients in their 40s-50s, or after MVA/trauma. I would hate if those were taken away.

And no, the commercial payors don’t always follow Medicare. In the Rockies I can do 3 level bilateral RFA with several commercial carriers, though the blues mostly follow Medicare facet guidelines.
 
bedrock said:
If I’m reading this correctly, this only applies to Medicare patients? If so then not a big deal as I generally go straight to RFA on Medicare patients anyway.
Click to expand...
How are you getting this covered? My precert department states medicare requires 2 medial branch blocks prefoed before consideration for rfa. And the advantage plans ask for specific levels and percent relief etc...
 
buddababa said:
How are you getting this covered? My precert department states medicare requires 2 medial branch blocks prefoed before consideration for rfa. And the advantage plans ask for specific levels and percent relief etc...
Click to expand...
My point was that I don’t offer IA facets to Medicare patients, only RFA. I do the usual two MBB first.

I only offer IA facets to younger patients and post MVA.
 
dipriMAN said:
Is anyone doing lumbar medial branch peripheral stimulation with sprint or other companies? Interested to hear if people are able to get this approved or are doing this?
Click to expand...
Just observed a Sprint PNS case today for lumbar medial branch stim (I am a fellow)
 
medgirl89 said:
Just observed a Sprint PNS case today for lumbar medial branch stim (I am a fellow)
Click to expand...
I think it would be a good option for the younger patient with facet pain you would rather not RF. Just not sure how it is getting approved or paid for.
 
dipriMAN said:
I think it would be a good option for the younger patient with facet pain you would rather not RF. Just not sure how it is getting approved or paid for.
Click to expand...
or how long its effects last after the 60 day timeframe. this is the key that I am waiting to see before moving forward w/ Sprint.
 
well this just gets better. premera in my area (Seattle exurbs), is now denying thoracic MBB/RFA as investigational as of Jan 2021!!! WTF. Gonna have to be all cash RFA by the end of this year at this rate
 
Multimodal said:
well this just gets better. premera in my area (Seattle exurbs), is now denying thoracic MBB/RFA as investigational as of Jan 2021!!! WTF. Gonna have to be all cash RFA by the end of this year at this rate
Click to expand...
All the blues in my area have been denying ALL thoracic procedures above t12-l1 and below C7-t1 for a few years.
 
I just scheduled a Medicare patient for diagnostic MBB and his PA daughter wrote him back telling him to get the lumbar facet joint injection instead. Technically the new LCD policy does not start until 5/01. I'm worried that it would affect his ability to get the RFA later. What would you guys do? Go ahead and slip in one last facet joint injection?
 
Agast said:
I just scheduled a Medicare patient for diagnostic MBB and his PA daughter wrote him back telling him to get the lumbar facet joint injection instead. Technically the new LCD policy does not start until 5/01. I'm worried that it would affect his ability to get the RFA later. What would you guys do? Go ahead and slip in one last facet joint injection?
Click to expand...
You a doc or a dog?
 
Just got notification in midwest that medicare and its replacement plans are allowing ONLY 1 to 2 levels unilateral or bilateral MBB/RFA going forward. Three level or 4 level (rare) procedure is only under case by case bases.
 
Does anyone know for certain if this applies to the advantage plans as well or just straight Medicare?
 
buddababa said:
Just got notification in midwest that medicare and its replacement plans are allowing ONLY 1 to 2 levels unilateral or bilateral MBB/RFA going forward. Three level or 4 level (rare) procedure is only under case by case bases.
Click to expand...
So we have to pick one joint to denervate? Or are we talking about the joints being denervated?
 
buddababa said:
Just got notification in midwest that medicare and its replacement plans are allowing ONLY 1 to 2 levels unilateral or bilateral MBB/RFA going forward. Three level or 4 level (rare) procedure is only under case by case bases.
Click to expand...
That is nuts!

time to drop all the Medicare advantage plans
 
buddababa said:
Just got notification in midwest that medicare and its replacement plans are allowing ONLY 1 to 2 levels unilateral or bilateral MBB/RFA going forward. Three level or 4 level (rare) procedure is only under case by case bases.
Click to expand...
4 level?? When did u ever do a 4 facet joints (unless you mean bilateral)?
 
imo if you have to do 4 levels bilaterally each and every time, you aren't examining the patient.... I so rarely did 3 levels.
 
Ducttape said:
imo if you have to do 4 levels bilaterally each and every time, you aren't examining the patient.... I so rarely did 3 levels.
Click to expand...
Agree. I never do 4 level. Just was stating what the policy read.

But now in the Midwest with medicare replacement plans not paying for genicular RFA, denying vertiflex and now this change; definitely making it harder to help patients. I fear soon people will just give up fighting those companies and start handing out more opioids.
 
So if someone has facet disease at L4-5 and L5-s1, we have to choose which one of these should be the target for mbb? So can’t do L3, 4 mbb and L5 dr?
 
The guidelines are strange to say the least .
It definitely making multiple levels harder to get paid. There is also and exclusion of MBB for ALIF surgery , which makes no sense . I think they meant PLIF... weird
 
spondy14 said:
So if someone has facet disease at L4-5 and L5-s1, we have to choose which one of these should be the target for mbb? So can’t do L3, 4 mbb and L5 dr?
Click to expand...
No. You bill by the facet joint, not by the medial branch nerve. That’s been the case for a long time. You can do 2 joint levels unilateral or bilateral, so L4-5 and L5-S1 bilateral RF is ok.
 
10KHertz said:
The guidelines are strange to say the least .
It definitely making multiple levels harder to get paid. There is also and exclusion of MBB for ALIF surgery , which makes no sense . I think they meant PLIF... weird
Click to expand...
My group had a conference call with Medicare where we pointedly asked certain questions. Yes, no facet procedures at ALIF or ACDF, even if posterior elements are untouched.

Yes, we bill by joints, so you can do either single level (2 Medial branch) or two level (3 medial branch) unilateral or bilateral RF. No 3 level (4 medial branch) unilateral or bilateral.

I'm still trying to figure out if this applies to the Medicare Advantage plans as well or just straight Medicare. Anyone have any info how this works?
 
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