Noridian non-coverage

[Dr. Ice]

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Members do not see this ad.

anyone have any thoughts on the recent news about Noridian's non coverage of facet injections/RFA??

 

[PAINBILLER]

I only saw a bulletin dated 8-14-09 which dealt with the correct use of modifier 50 when billing the additional levels. I don't see anything about non-coverage. Can you share where you saw that information?

 

[Dr. Ice]

SPECIAL Action Alert for ISIS Members
Noridian Non Coverage of Lumbar Facet Procedures

ISIS Sample Letter provided for comments to Noridian due by 8/31/2009


Noridian Administrative Services, a major Medicare contractor has recently proposed non-coverage for lumbar facet joint injection and medial branch block CPT codes 64475, 64476, and the corresponding RF neurotomy codes 64622 and 64623. If this proposed policy is implemented, these facet-related CPT codes with no longer be covered and reimbursed by Medicare in the affected states (Alaska, Arizona, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming, etc.). A non-coverage determination by Noridian may subsequently be utilized as a basis for a National non-coverage determination by CMS and will thus likely have NATION-WIDE IMPLICATIONS.

The LCD Policy can be accessed at:

http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=30219&lcd_version=5&show=all

NOTE - You must agree to the Noridian Disclosure Agreement at the bottom of the page by clicking <Accept> before you will able to view the LCD Draft.


Over the last couple months, leaders of ISIS, NASS, AAPM, AAPM&R, SIR, and other societies have worked to develop a consensus response requesting immediate removal of these CPT codes from the proposed non-coverage list. Additionally, a scientifically-based Local Coverage Determination (LCD) proposal has been drafted and is supported by the ISIS Board and aforementioned societies. We believe the proposed multi-society LCD will address the issues of overutilization, miscoding, and potential fraudulent coding highlighted in the Office of the Inspector General (OIG) report regarding facet injections released in September 2008. The consensus proposal would also support proposed CPT edits requiring image guidance for these procedures, and maintain appropriate access for Medicare beneficiaries with lumbar facet joint pain.

YOUR INVOLVEMENT IS NEEDED NOW. THE DEADLINE TO RESPOND IS AUGUST 31 AT 12 NOON PST, after which time the comment period ends and Noridian will cease accepting letters and comments.

A sample letter is provided below that can be individualized. We suggest keeping your response brief, professional and factual.



Updated Noridian contact information for response:

EMAIL your response or letter to:

Noridian Administrative Services LLC Contractor Medical Director(s)
Policy Development - Medicare Part B - Drafts
900 42nd Street S.
P.O. Box 6740
Fargo, ND 58108
Email: [email protected]

More information for reference is available by clicking on the following links:
Proposed LCD for Noridian's consideration
A PowerPoint presentation of consolidated evidence with an appeal that complements the other documents

SAMPLE LETTER for ISIS Members: We encourage you to modify or re-write this in your own voice and practice letterhead. Please remember to sign the letter. Click here for the Word version. This letter can be emailed to: [email protected]
____________________________________________________________________________________

[Insert Date]

Noridian Administrative Services, LLC
Attn: Part B Medical Director
P.O. Box 6740
Fargo ND 58108-6740


Dear Medical Directors:

REGARDING: Noridian proposed non-coverage (DL24471) of CPT codes 64622, 64623, 64475 and 64476 (lumbar facet blocks and denervation procedures)

As a member of International Spine Intervention Society (ISIS), I stand with more than 3,000 Board Certified spine care specialists, including anesthesiologists, physiatrists, radiologists, neurosurgeons, and orthopedic spine surgeons, and request the immediate removal of the lumbar facet joint/nerve injection and RF (denervation) codes (64475-76 & 64622-23) from your proposed non-coverage list.

As a physician who specializes in the diagnosis and treatment of spine pain on a daily basis, I find it inconceivable that the above referenced CPT codes (64475-76, 64622-23), which have proven diagnostic and therapeutic value, would be removed from coverage to the detriment of Medicare beneficiaries.

If the proposed non-coverage policy is implemented, it will limit the ability of providers to adequately evaluate and subsequently treat patients who suffer with facet joint mediated pain and the associated debilitation and impairments that result. This will contribute to continued misdiagnosis of low back pain in the affected population, over-utilization of other unnecessary diagnostic tests, perpetuation of ineffective therapies or inappropriate treatment, including surgical interventions, and contribute to escalating health care costs in this patient population.

ISIS fully supports efforts to optimize resource utilization and reduce inappropriate expenses by addressing the concerns noted in the OIG report (September 2008, OEI-05-07-00200) regarding the overutilization and inappropriate coding of these procedures.

I believe the proposed LCD and response submitted on behalf of our ISIS membership is appropriate and recommendations outlined therein should be implemented by Noridian.

Respectfully Submitted,

[Insert Name, Specialty, Address]

 

[PAINBILLER]

Thanks

 

[Mister Mxyzptlk]

My letter wasn't so nice.

August 22, 2009

Noridian Administrative Services, LLC
Attn: Part B Medical Director
P.O. Box 6740
Fargo ND 58108-6740

RE: Noridian proposed non-coverage (DL24471) of CPT codes 64622, 64623, 64475 and 64476 (lumbar facet blocks and denervation procedures)

Dear Medical Directors:

I am a board-certified pain specialist who has been in practice for 30 years. I understand the concerns noted in the OIG report (September 2008, OEI-05-07-00200) regarding the overutilization and inappropriate coding of these procedures. I agree that fraud and abuse exists. However, your solution throws the baby out with the bath water. Why don't you take measures to ensure that those who abuse the procedure are deprived of the opportunity, rather than deprive the patients of the procedure?

Your proposal condemns suffering patients to unnecessary pain. It is your own failure to have adequate policies and procedures in place that has led to this debacle - not the honest doctors or the suffering patients. Your solution would punish both of these innocent parties. You would rather take the easy way out with insane proposals like this than do the hard work of dealing with bad actors. This is one reason why people do not trust the government to manage health care.

I believe the response submitted by ISIS is far more appropriate and the recommendations outlined therein should be implemented by Noridian. Noridian's approach is, as stated above, completely devoid of reason and hurts innocent people.

 

[Doctodd]

i know you left out some juicy parts......or edited them. Dont sugar coat it....im sending one of the AMA solicitiation postcards(with their own postage) back to them saying Rohack needs to grow some balls. Noridian might need a similar response.

 

[Mister Mxyzptlk]

I snipped out some stuff about a local doc that I blew the whistle on. His Medicare fraud alone was about $25M. He billed Medicaid for about 2,000 intercostal blocks. If I hadn't said anything they never would have known. I had to shop it around to even get anyone to look at him. He'd been at it for 20 years. That went into the letter to Noridian but for discussion purposes and talking points I edited it.

 

[Doctodd]

i think i recently read about that Indian couple......they had been funneling money to India and had ~$820,00 in a safe deposit box. Glad u helped get them shut down. Dont u get a 3% commission or something like that? 3% of 25million wouldnt be bad.

 

[drrinoo]

i think i recently read about that Indian couple......they had been funneling money to India and had ~$820,00 in a safe deposit box. Glad u helped get them shut down. Dont u get a 3% commission or something like that? 3% of 25million wouldnt be bad.

What the hell does race have to do with anything?

'that Indian' or them folks

I could also swipe about the evil pill mills in Miami

Also Gawande's article (an Indian American) wrote about the high billing practices in parts of Texas (McAllen)--he alluded to potential abuses, but never came out and said anything

Bad and renegade physicians are bad and renegade physicians, irrespective of geography, melanin concentrations, or memetic preferences

 

[PMR 4 MSK]

What the hell does race have to do with anything?

'that Indian' or them folks

I could also swipe about the evil pill mills in Miami

Also Gawande's article (an Indian American) wrote about the high billing practices in parts of Texas (McAllen)--he alluded to potential abuses, but never came out and said anything

Bad and renegade physicians are bad and renegade physicians, irrespective of geography, melanin concentrations, or memetic preferences

And the 'Smackdown Of The Week' award goes to....

drrinoo!!!

 

[mille125]

What the hell does race have to do with anything?

'that Indian' or them folks

I could also swipe about the evil pill mills in Miami

Also Gawande's article (an Indian American) wrote about the high billing practices in parts of Texas (McAllen)--he alluded to potential abuses, but never came out and said anything

Bad and renegade physicians are bad and renegade physicians, irrespective of geography, melanin concentrations, or memetic preferences

I am very sensitive to racial prejudice given that I am a minority. However, I feel that you are taking this out of context.

 

[Doctodd]

anger management?......i remembered bits and pieces about what i read.....the $817K in a safe deposit box, and the transferring of money to India by a married Indian couple who were doctors.

Sry if u were offended....i wouldnt want to cut you off in traffic.

 

[Tenesma]

yeah - i don't think there was anything racial about that comment --- the term was used as a descriptor

anyway, with medicare you get a % of the fraud up to $1,000... but i believe that is per claim.... so a % of a ton of claims could net you something nice.... now i don't know if that is based on claims or % of what is recovered???

 

[Ligament]

I declare there were no racist undertones here. 🙂

 

[Mister Mxyzptlk]

I didn't perceive the descriptor as pejorative either, but any minority ethnic group is sensitive when one of their own does something disreputable because it might reflect on the entire community.

As far as I can tell nobody has put an ethnic spin on the case. The general feeling is that they were just bad people, period.

 

[Aether2000]

A joint statement, spearheaded by ISIS, and joined by the presidents of 10 other pain related organizations, was sent to Noridian yesterday decrying their tactics. ASIPP was the only pain organization that refused to sign, and it appears they are going their own way in approaching Noridian. Hopefully the joint efforts by the like minded coalition of pain societies will have an effect in reversing Noridian's policies.

 

[AviatorDoc]

Any idea what ASIPP's tactic is?

Also, fraud and abuse know no color/ethnic boundaries. Greed is ubiquitous. It's unfortunate that some jackasses are ruining an important field of medicine in the name of making a buck. Everyone can make a decent living at this, practice good medicine, seek out good patient outcomes, and get the damn government out of our pockets.

(stepping off soapbox now)

 

[Ligament]

A joint statement, spearheaded by ISIS, and joined by the presidents of 10 other pain related organizations, was sent to Noridian yesterday decrying their tactics. ASIPP was the only pain organization that refused to sign, and it appears they are going their own way in approaching Noridian. Hopefully the joint efforts by the like minded coalition of pain societies will have an effect in reversing Noridian's policies.

Algos, thanks for the update. By any chance, can you share the joint statement with us? I have not recieved a copy from any organization. Being in Washington state, my patients and I willl be directly screwed by this ruling if Noridian proceeds with their misguided thoughts. Thanks brother!

 

[Finally M3]

Here ya are, Ligament

 

[Mister Mxyzptlk]

ASIPP was the only pain organization that refused to sign, and it appears they are going their own way in approaching Noridian.

The insurers and politicians don't have to divide and conquer. Thanks to ASIPP we are doing it to ourselves. I stopped contributing to their PAC when it became apparent that ASIPP was only protecting ASCs (not specialty hospitals or office-based procedures). Now I think it's time to drop membership.

"The Voice of Interventional Pain Management done in an ASC"

 

[Disciple]

A joint statement, spearheaded by ISIS, and joined by the presidents of 10 other pain related organizations, was sent to Noridian yesterday decrying their tactics. ASIPP was the only pain organization that refused to sign.

Refused?


Seems odd.


I've been getting some e-mails from them with their own template attached.