I know interventional spine has been discussed before, but most of these threads are older.. I wanted to include interventional procedures in my outpatient pm&r practice when I'm done with residency. Recently there has been some decisions made by the Medicare carrier Noridian to drop payments for I believe it was transforaminal and epidural inj d/t lack of evidence as to their efficacy v.s placebo. I know with the health care talk in our nations' capitol pain procedures may be on the chopping block anyway. Does anyone have any insight, news, worries about this? Given these developments, and the fact that hospitals, etc want ACGME accrediation, would it be best to do ACGME pain v.s. PMR spine/msk/PASSOR type fellowships even if I had no intention of doing procedures in a hospital? Would reimbursement from insurance or malpractice/CYA concerns be an issue here? Does anyone even think it matters much if pain is really going the way of the dinosaurs? I havent gotten any real solid answers on these questions (that could be because there are none, I realize). Thanks!
recent changes in coverage of interventional spine procedures
- Thread starter jeahfoo
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I do not know what will be reimbursable or not in the future. Lets realize that for Medicare there are NCDs and then their are LCDs. Noridian's choice reflects an LCD- or local coverage determination- which occurs when there is no national coverage determination in place. My understanding was that this event you are referring to involves facet joint blocks, but since my state isn't in Noridian territory I am really not sure.
One man's( and woman's) facet joint block is another one's nerve block, For someone else it might be a trigger point injection. Consider what I am saying and realize there are a myriad of codes that cover these procedures.
Also, I would venture that medicare will try and move towards a single price tag per illness scenario, where, lets say a pain case, gets one reimbursement that is divided by many. Try and adjust your thinking to this type of reality. if you are in medical school thinking about billing and coding and reimbursement methods that don't yet exist may not be a priority and perhaps it shouldn't be.
But that would be my initial answer to at least clarify the reimbursement waters a little.
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Reimbursements for procedures have been falling off a cliff; I have no doubt this will continue.
The best thing you can do if you are starting training is diversify your skill set.
The best thing you can do if you are starting training is diversify your skill set.
yeah but it raised mine
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Insurance is irrelevant. Once they railroad through this public option, there won't be any private insurance (and maybe not even any Medicare or Medicaid) in 10 years, just one government plan for everyone... which most certainly won't want to pay for back injections, as its much cheaper to hand out Oxycontins to everyone (or possibly Obama's choice, weed). 😴
When I moved to OK, I was a 1a if I did not do spinal injections. I was a 2b if I did. That changed my premiums by over $10,000. I stopped doing spinal injections.
