New Nationwide Policy on Facet Joint Interventions

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

I still get the impression that medicare does track the levels, but not whether or not there is a fusion present as that it is too hard for them to follow.
I sometimes do cervical RFA on patients s/p ACDF and s/p ALIF, and medicare still pays me.

Members don't see this ad.
 
  • Like
Reactions: 1 user
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?
No RF for ACDFs??
 
i wouldnt use the fact that medicare has paid as a marker of approval from Medicare. if it is a procedure listed under Medicare, if you do the procedure and bill medicare, you will get paid irrespective of whether the procedure satisfies the guidelines.

you only find out you did it wrong after Medicare does an audit, which may require you to pay back. im pretty sure this is what leads to a lot of those announcements that a doctor has bilked medicare....
 
  • Like
Reactions: 2 users
Members don't see this ad :)
i wouldnt use the fact that medicare has paid as a marker of approval from Medicare. if it is a procedure listed under Medicare, if you do the procedure and bill medicare, you will get paid irrespective of whether the procedure satisfies the guidelines.

you only find out you did it wrong after Medicare does an audit, which may require you to pay back. im pretty sure this is what leads to a lot of those announcements that a doctor has bilked medicare....
this is exactly why I started using contrast for my MBB's. The LCD in our area requires an xr with contrast flow to be saved showing no vascular or muscular pickup. I never did this until i moved to WA state. I always thought it was overkill and just exposed the patient to more unnecessary drugs. I have seen no clinical change other than im sleeping better at night knowing I wont be dinged in an audit for some stupid technicality like not mixing contrast with my local for an MBB.
 
this is exactly why I started using contrast for my MBB's. The LCD in our area requires an xr with contrast flow to be saved showing no vascular or muscular pickup. I never did this until i moved to WA state. I always thought it was overkill and just exposed the patient to more unnecessary drugs. I have seen no clinical change other than im sleeping better at night knowing I wont be dinged in an audit for some stupid technicality like not mixing contrast with my local for an MBB.
Same. Well, for lumbar it seems superfluous. For cervical I’ve come around to the idea that it may make a difference at times.
 
Top