Osteoporotic compression fracture

[RoloTomassi]

Getting insurance pushback on kypho.

What exactly needs to be documented to call a fracture from low impact injury, like ground level fall, "osteoporotic" vs traumatic? Most people don't have DEXA. Do you have to get one after fx? Have to be certain age?

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[lobelsteve]

Getting insurance pushback on kypho.

What exactly needs to be documented to call a fracture from low impact injury, like ground level fall, "osteoporotic" vs traumatic? Most people don't have DEXA. Do you have to get one after fx? Have to be certain age?

Ground level fall and fx of any bone defines osteoporosis. Date of fall. Date of mri. Stir signal on mri. NRS 7+. Trial of med. Consider brace.
If bedridden admit and do kypho. If ambulatory give up to 7 days to get on schedule for kypho. Get clearance in that time period. Dexa whenever but that is just for medical management of osteoporosis.

 

[Agast]

What if someone falls from standing height and hits their back on a trailer hitch?

 

[nvrsumr]

I had dexa required by Humana Medicare in a lol with 4 acute vcf prior to kypho

 

[bedrock]

I had dexa required by Humana Medicare in a lol with 4 acute vcf prior to kypho

Ridiculous. Did you tell her nicely to switch back to regular Medicare if she doesn’t want to deal with similar headaches in the future ?

 

[lobelsteve]

What if someone falls from standing height and hits their back on a trailer hitch?

Trauma. But inherently biased. This was trailer hitch injury. I hate hitches.

 

[Inygma]

We recently were given denials on acute fracture because patient did not have DEXA scan and something along the lines of education about osteoporosis or something. I’ll have to find it.

Unfortunately after information/education was provided about osteoporosis her fracture did not unfracture and we did kypho.

Our new notes “recommend pcp complete dexa scan and follow up with education and materials on osteoporosis “ and we haven’t had that issue as much

 

[lobelsteve]

We recently were given denials on acute fracture because patient did not have DEXA scan and something along the lines of education about osteoporosis or something. I’ll have to find it.

Unfortunately after information/education was provided about osteoporosis her fracture did not unfracture and we did kypho.

Our new notes “recommend pcp complete dexa scan and follow up with education and materials on osteoporosis “ and we haven’t had that issue as much

Own the Bone.
Also good for referrals.
If you treat Fxs, you should treat the patient.

 

[Inygma]

Own the Bone.
Also good for referrals.
If you treat Fxs, you should treat the patient.

That’s fair. I guess it’s not much to order the dexa etc.

Are you managing osteoporosis though? This is at my fellowship and a lot of these patients are here just for kypho, not our chronic patients

 

[Agast]

Trauma. But inherently biased. This was trailer hitch injury. I hate hitches.

Put some mud on it and walk it off

 

[RoloTomassi]

Hawk tuah, spit on that thang

 

[sloh]

Medicare just needs some sort of imaging to mention findings consistent with osteoporosis. No DEXA needed.

 

[Laryngospasm]

Hawk tuah, spit on that thang

Was not expecting this.. lol

 

[manowar rules]

Ground level fall and fx of any bone defines osteoporosis.

Do you have a source I can cite that osteoporosis can be defined by a fragility fracture? I have gotten denials when DEXA
T-scores are in “osteopenia” range even with concurrent fracture.

 

[lobelsteve]

Do you have a source I can cite that osteoporosis can be defined by a fragility fracture? I have gotten denials when DEXA
T-scores are in “osteopenia” range even with concurrent

Osteoporosis Guidelines: Screening, Diagnosis, Treatment

Osteoporosis, a chronic, progressive disease of multifactorial etiology (see Etiology), is the most common metabolic bone disease in the United States. It has been most frequently recognized in elderly white women, although it does occur in both sexes, all races, and all age groups.

emedicine.medscape.com

AACE guidelines for the last 20 years as well.

Search the forums as there have been several “own the bone” threads.

 

[lobelsteve]

Common side effects for Tymlos, Evenity, Prolia highlighted compared to placebo.

 

[SC Tian]

How many folks do office-based kyphoplasty? what is your setting like iv, conscious sedation versus oral, EKG monitoring, single c arm, unipedicular, etc? Thanks.

 

[lobelsteve]

No iv. Ativan offered 1mg #2. Unipedicular. No monitor.

 

[pmrmd]

No iv. Ativan offered 1mg #2. Unipedicular. No monitor.

No IV abx?

 

[lobelsteve]

No IV abx?

IV for ABX or IM Abx, but no IV left in for procedure.

 

[SC Tian]

No iv. Ativan offered 1mg #2. Unipedicular. No monitor.

Do you use full surgical drape, or just transparent drape like epidural?

 

[nvrsumr]

How many folks do office-based kyphoplasty? what is your setting like iv, conscious sedation versus oral, EKG monitoring, single c arm, unipedicular, etc? Thanks.

IV for abx and left in place. infrequently 1-2 mg versed. pox ,HR and BP no ekg, single arm, parapedicular, full drape and full gown. Lido with epi thru trocar as advancing and prior to ballon.

 

[drrosenrosen]

IV for abx and sedation. Versed and 15-25mg of ketamine, lots of local, single C-arm. Unipedicular with MDT Curve, EKG/BP/Pulse ox

 

[SC Tian]

IV for abx and sedation. Versed and 15-25mg of ketamine, lots of local, single C-arm. Unipedicular with MDT Curve, EKG/BP/Pulse ox

Thanks for sharing, I heard ketamine works fairly well for this office kypho, wonder if it can be combined with fentanyl or toradol maybe if there is still more pain in lying flat.

 

[SC Tian]

We are planning to do office-based kypho, we will use an office space that is connected to the hospital and ER, and we can even code for medical emergencies. I am planning to get CRNA to work, anyone has any idea if they can bill the MAC for office procedures? My impression is yes.

 

[lobelsteve]

Do you use full surgical drape, or just transparent drape like epidural?

Half sheet and 26x18 fenestrated drape. Never used clear. And a 25 gauge spinal needle to numb from the skin down to the pedicle and get subperiosteal.

 

[PinchandBurn]

I have switched from nurse sedation to po...usually 1mg Xanax. 5 to 10mg Norco 1 tab. Lots of local. Iv for abx...

 

[BobBarker]

5-10mg diazepam and nitrous, lots of local. They tolerate it well. Pulse ox only. Large, Fenestrated drape.

 

[lobelsteve]

5-10mg diazepam and nitrous, lots of local. They tolerate it well. Pulse ox only. Large, Fenestrated drape.

The drape. I don't know why, but most of my OR days is just an implant then a kypho.
First case gets the narrow lap. second case gets the large lap with the plastic pocket at the bottom.
Always needing to cut away the narrow drape to get to the pocket. Blue towels under to frame the field. No idea why.

 

[manowar rules]

5-10mg diazepam and nitrous, lots of local. They tolerate it well. Pulse ox only. Large, Fenestrated drape.

Hi, what sort of mask do you use for the nitrous? Do you just turn their head to the side, or any issues with the mask staying on?

Do you have any special storage for the nitrous when not in use, or does the cylinder just sit in a closet?
Thank you for helping with my questions!
I understand the safety of 50/50 nitrous and I have proposed using nitrous in my office, but my (large PP) employer wants a special storage protocol among other red tape. I guess they are worried about us having nitrous parties like the dentists.

 

[BobBarker]

#5 face mask fits perfectly under my small oakworks head postioner. The mixer and the two cylinders in use just sit out all of the time. I have the two backup cylinders in the appropriate wire storage racks. Someone abusing the nitrous would be caught pretty quick. The cylinders are much, much smaller than the ones the dentists use with the plumbed systems.