Qutenza

[drg123]

I wil have a large population of patients with diabetic peripheral neuropathy and other neuropathies and thinking about efficacious treatments I can offer them. Qutenza has caught my attention. Anyone doing this with frequency here for their patients? How is the prior auth process and reimbursement? The company says the patch can be applied by non-physician (Nurse/MA), as long as physician evals and chooses area to apply. 30 min application. No more rec for EMLA pretreat. Seems easy. Multiple CPT codes suggested but I was told 64640 (Destruction by Neurolytic Agent (eg, Chemical, Thermal, Electrical or Radiofrequency) Procedures on the Somatic Nerves, 1.98 wRVU) most commonly billed. Curious to hear people's experiences and your thoughts on efficacy and the worthiness of offering the treatment. Thanks!

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[runfastnow]

The two patients I've used on have done really well with it. Super easy to apply as long as you've got space to have an exam room clogged up for 35 minutes. Cut the patch to fit, apply, use the provided gel to wipe off the treated area. My n=2 have had headaches getting approval but it does seem to be effective if they've failed meds, etc. - used for one CMT and one DM2 peripheral neuropathy.
I would still pre-treat with OTC lidocaine patch or EMLA. A patient forgot his pre-Qutenza lido patch on one of his treatments and complained of some significant burning compared to lido pre-treat.

 

[drg123]

The two patients I've used on have done really well with it. Super easy to apply as long as you've got space to have an exam room clogged up for 35 minutes. Cut the patch to fit, apply, use the provided gel to wipe off the treated area. My n=2 have had headaches getting approval but it does seem to be effective if they've failed meds, etc. - used for one CMT and one DM2 peripheral neuropathy.
I would still pre-treat with OTC lidocaine patch or EMLA. A patient forgot his pre-Qutenza lido patch on one of his treatments and complained of some significant burning compared to lido pre-treat.

Very helpful! thank you. Good to hear. We have a post-procedure monitoring area that the patients could sit in so doesn't take up a room. Any post-application monitoring? I think the pre-application EMLA and (previous) recommendation to do monitoring after diminished enthusiasm for Qutenza in my group. For example, Aetna has this on their site:

Qutenza must be applied to the skin by a health care professional since placement of the patch can be quite painful, requiring use of a local topical anesthetic, as well as additional pain relief such as ice or use of opioid pain relievers. The patient must also be monitored for at least 1 hour since there is a risk of a significant rise in blood pressure following patch placement. The product insert of Qutenza states that the patches should be applied to the most painful skin areas, using up to 4 patches. Furthermore, the patches should be applied for 60 minutes and repeat every 3 months or as warranted by the return of pain (not more frequently than every 3 months). Post-Herpetic Neuralgia - Medical Clinical Policy Bulletins | Aetna

I don't see this recommended any longer though from the company

https://qutenzahcp.com/pdfs/Qutenza_DPN_Administration_Guide_2023.pdf

So if it's just treat (30 mins), cleanse and be done, seems like worth a shot, especially given how low risk.

 

[Baron Samedi]

I've done 30 mins without lidocaine and pts tolerated it just fine.

 

[runfastnow]

No post-application monitoring that we do. Coban wrap/tape helps keep patch in place if that isn't in the Qutenza guide.

 

[lobelsteve]

Not so sure your CPT is appropriate.

 

[drg123]

Not so sure your CPT is appropriate.

https://qutenzahcp.com/pdfs/QZA-02-22-0023_v12_August-2023-Reimbursement-Guide_AFD_082223.pdf

Wiki - Qutenza Questions

I am researching the use of the Qutenza patch for PHN and DPN. I've found almost everything I need, however, I've run across conflicting information regarding the correct administration code. I believe I have it narrowed down to either 64999 or 17999. This treatment is new to our providers and I...

www.aapc.com

Just passing along what rep told me and company's guidance

 

[Ronin1]

I spoke to these guys last year at Aspn. I don’t think this would hold up billing as a nerve destruction code. Most likely have to bill a 99214 only. It doesn’t really pencil out financially

 

[cowboydoc]

View attachment 387802

https://qutenzahcp.com/pdfs/QZA-02-22-0023_v12_August-2023-Reimbursement-Guide_AFD_082223.pdf

Wiki - Qutenza Questions

I am researching the use of the Qutenza patch for PHN and DPN. I've found almost everything I need, however, I've run across conflicting information regarding the correct administration code. I believe I have it narrowed down to either 64999 or 17999. This treatment is new to our providers and I...

www.aapc.com

Just passing along what rep told me and company's guidance

Trusting a rep with proper coding is a poor choice.

 

[lobelsteve]

999 code. Saying you are ablatinig a named nerve is not wise. Clawbacks a coming for you.

 

[drg123]

Ultimately, I will code whatever our institutional billing people tell me is acceptable and appropriate. I agree, no extra RVU pellets are worth the possibility of trouble down the road. Just collecting information right now. 999 sounds fine if that's how to do it.

Some similar recent discussion I found here:

Physician burnout due to bureaucrats

https://www.nytimes.com/2023/02/14/health/doctors-medical-guidelines.html

forums.studentdoctor.net

 

[Agast]

If the treatment takes 60 minutes in office, why not bill a 99215? For time-based billing.

I’m sure it happens so infrequently it won’t trigger an audit anyway.

 

[Ducttape]

but you are not providing active medical care (such as counselling etc), so it wont qualify for time based billing.

we looked into that.

the most appropriate code we were told was 64999.

 

[Agast]

but you are not providing active medical care (such as counselling etc), so it wont qualify for time based billing.

we looked into that.

the most appropriate code we were told was 64999.

What if you have your MA document vital signs q5 minutes

 

[Ducttape]

for 99215 - its still not you actively providing care.

time based billing is the time you spend with the patient.

 

[Agast]

for 99215 - its still not you actively providing care.

time based billing is the time you spend with the patient.

Ok what if I spin the blood pressure cuff myself 😉

 

[drg123]

Appreciate the discussion. Seems not straightforward. Found this discussion to further add to the confusion

Wiki - Qutenza J7336 application CPT/HCPCS

I am a facility coder for a hospital system that is primarily Medicare and Medicaid patients. I also work denials, NCCI edits, payer specific edits etc for OPPS billing. Our pain management and wound care clinics want to start using and charging for Qutenza capsaicin patches and application...

www.aapc.com

At least one medicare administrator made some specific guidance:

news article details - NGSMEDICARE

www.ngsmedicare.com

There are currently no CPT codes specific to an administration of Qutenza. Therefore, National Government Services recommends that providers use CPT code 17999 (Unlisted procedure, skin, mucous membrane and subcutaneous tissue) during the administration of Qutenza. The reimbursement will analog to CPT code 17360.