Repeating RF for MC patients

[knoxdoc]

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For those working in Noridian MC states, do we need to repeat MBBs prior to repeating RF if a patient had >50% relief for more than 6 months? I don't want to have them retroactively deny the RF.

 

[onewithpain]

I repeat MBBs because of my Noridian paranoia. My office has told me that they are auditing my MBBs, but no negatives yet. Have you looked at Noridian's web page with criteria for MBBs? Its a little vague, like 'failed conservative therapy' and 'other etiologies have been ruled out'. Some of the privates seem to be following suit but are more specific about their criteria.

 

[knoxdoc]

They are not clear about the RF. It just says that it can't be repeated unless there is 6 months of >50% pain relief. I'm sure they will stick it to me somehow.

 

[onewithpain]

The last time I read the criteria for RFA, Noridian required 2 separate MBBs prior to RFA. You could repeat the RFA after 6 months but they don't say specifically that you need to repeat the MBB prior to a repeat RFA. It could easily be extrapolated to imply that you can never do an RFA unless you have had 2 MBBs, and since they allow 4 MBBs/level per year and 2 RFAs/level per year then the math would suggest MBB first, then RFA.