RF Generator - Cosman vs. Neurotherm?

[CaliDr]

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.My practice is looking into purchasing an RF generator in the near future and I wanted to see if any of you have had experience with both/either (and with the up-keep for that matter). They both seem to have good qualities…any experience with either that you feel like sharing would be appreciated.



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[lobelsteve]

.My practice is looking into purchasing an RF generator in the near future and I wanted to see if any of you have had experience with both/either (and with the up-keep for that matter). They both seem to have good qualities…any experience with either that you feel like sharing would be appreciated.



.

I love my Stryker quadzilla unit.
I trained on the old Radionics box- so a small fire and skewer were superior technology.

 

[pmrmd]

i like my neurotherm nt1100 3 nerve unit. pulse and thermal capabilities. my only bitch is those probes don't last as long as they ought to. i treat them better than my kids and i don't get 9-12 months before they fail.

 

[lobelsteve]

Going on 4 years without a probe failure on my Stryker.
Hand wiped with a cavi-wipe then bagged and Ritter M9'd.
I average ~8 RF's per week.

 

[pmrmd]

Going on 4 years without a probe failure on my Stryker.
Hand wiped with a cavi-wipe then bagged and Ritter M9'd.
I average ~8 RF's per week.

don't rub it in

 

[Jcm800]

Going on 4 years without a probe failure on my Stryker.
Hand wiped with a cavi-wipe then bagged and Ritter M9'd.
I average ~8 RF's per week.

Love the stryker...

 

[emd123]

Alright, what do you think?

Starting a new practice with big group. Will only Pain guy in primary care group with 20+ docs. Are these, 1) Good machines, and 2) Are these reasonable quotes, 3) Would I be insane not to buy refurbished or lease, 4) Do I need units this good, and 5) Where the heck do you buy a frickin' refurbished RF machine anyways? Craig's List? Garage sale? (Just Kidding)

Stryker Multigen: $25,000 with cables, controller etc. or,

Cosman G4: $26,000.

 

[Ligament]

Alright, what do you think?

Starting a new practice with big group. Will only Pain guy in primary care group with 20+ docs. Are these, 1) Good machines, and 2) Are these reasonable quotes, 3) Would I be insane not to buy refurbished or lease, 4) Do I need units this good, and 5) Where the heck do you buy a frickin' refurbished RF machine anyways? Craig's List? Garage sale? (Just Kidding)

Stryker Multigen: $25,000 with cables, controller etc. or,

Cosman G4: $26,000.

Get the Baylis or Neurotherm. Get the baylis if you need cooled RF technology for SIJ, lumbar, thoracic RFA. Cooled RFA is rarely reimbursed FWIW.

Get the Neurotherm if you need Pulsed Dose mode (constant 45V per pulse) or like the simplicity probe.

 

[emd123]

Get the Baylis or Neurotherm. Get the baylis if you need cooled RF technology for SIJ, lumbar, thoracic RFA. Cooled RFA is rarely reimbursed FWIW.

Get the Neurotherm if you need Pulsed Dose mode (constant 45V per pulse) or like the simplicity probe.

Neurotherm 1000?

 

[Ligament]

I'd suggest the NT2000. Get the best RF and fluoro machine you can.

 

[nvrsumr]

I have purchased two different cosmans and liked both of them. Good rep which helps.

 

[drf]

Get the Baylis or Neurotherm. Get the baylis if you need cooled RF technology for SIJ, lumbar, thoracic RFA. Cooled RFA is rarely reimbursed FWIW.

Get the Neurotherm if you need Pulsed Dose mode (constant 45V per pulse) or like the simplicity probe.

By cooled RF not being reimbursed, do you mean using that mode/equipment for any RF use? Do you have to code it or dictate it different from a normal RF and this gets tagged for denial?

Or is it that the equipment is more expensive and you only get reimbursed as you would for cheaper tech?

 

[epidural man]

.My practice is looking into purchasing an RF generator in the near future and I wanted to see if any of you have had experience with both/either (and with the up-keep for that matter). They both seem to have good qualities…any experience with either that you feel like sharing would be appreciated.



.

If you don't get the neurotherm, you are ******ed (was that too strong?)

It is the only machine I am aware of that allows you to hold steady your "dose" during pulsed RF. Why would you not want to maintain the same electrical field during pulsed RF. Every other machine only holds temp constant (which has nothing to do with the effect you are trying to achieve) and voltage goes all over the place during treatment, and usually is way to low.

People say pulsed doesn't work? It probably doesn't if your voltage was 10-20 and was changing during the whole pulsed sequence.

Get the neurotherm and do it right. Hold voltage constant. Be a man and so you can say - "I produced this type of electrical field that remained constant for this amount of time!"

The rest of us, if we were asked - "well what dose did you give during your pulsed treatment? What was the state of the electrical field?" We will have to answer - "Hell if I know. At least the temperature stayed at 42C."

 

[Ducttape]

first time i used pRF, i got freaked out because the temp only went to 32.7 degrees - block lasted 9 months 🙂

 

[Ligament]

If you don't get the neurotherm, you are ******ed (was that too strong?)

It is the only machine I am aware of that allows you to hold steady your "dose" during pulsed RF. Why would you not want to maintain the same electrical field during pulsed RF. Every other machine only holds temp constant (which has nothing to do with the effect you are trying to achieve) and voltage goes all over the place during treatment, and usually is way to low.

People say pulsed doesn't work? It probably doesn't if your voltage was 10-20 and was changing during the whole pulsed sequence.

Get the neurotherm and do it right. Hold voltage constant. Be a man and so you can say - "I produced this type of electrical field that remained constant for this amount of time!"

The rest of us, if we were asked - "well what dose did you give during your pulsed treatment? What was the state of the electrical field?" We will have to answer - "Hell if I know. At least the temperature stayed at 42C."

Actually, the top of the line Cosman unit has the same feature. They call it "E-Dose." It may even be more advanced than the Neurotherm Pulsed Dose feature, as I don't think Neurotherm allows variation of pulse width, rate, whilst maintaining constant voltage, but could be wrong.

"Pulsed RF (480 kHz carrier frequency)
Auto Temperature: Off, 37–95°C
Auto Timer: 5 sec – 30 min
Voltage: 0-100 Volts Peak
Rates: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 Hz
Widths/Durations: 2, 3, ... , 30 msec
E-dose: Control Voltage or Pulse Width"

Of course, all of this could have absolutely zero relevance as we have no idea which settings for pulsed RF are best, and the literature is still poor on pulsed RF.

 

[epidural man]

Of course, all of this could have absolutely zero relevance as we have no idea which settings for pulsed RF are best, and the literature is still poor on pulsed RF.

Tru dat!

but at least it is a step forward rather than just setting a temperature and reporting that (which is what MOST of the articles do)

 

[xXAnksXx]

1)STRYKER
2)COSMAN
3)NEUROTHERM

the stryker is a tank!

 

[craigkes]

Agree with Stryker. Tried out the new "Venom" as well as the new Neurotherm. Liked the interface better for neurotherm but the Stryker seemed like I could lesion a football field. Yes, I understand correct location of the needle to start is the key but man it was nice. The only thing I didn't like was the pain with the lesioning. I don't sedate my MBB's but I do give a little something to take the edge off for the RFA. I trialed both units and the Stryker Venom was very painful for everyone I did it on (trialed 4 patients-1 genicular and 3 lumbar) irregardless of how much lido I gave before the lesioning and the time waited. This as compared to the crappy (old) Baylis I used during fellowship and the Neurotherm unit I trialed. Maybe I should flood with 5 ml's after testing, I don't know. The Neurotherm needles were a lot smoother for placement however, as a side note. Some sort of special coating on the outside (silicone?) made it nice and effortless.

 

[pmrmd]

I have an NT1100 and Stryker Quadgen and I'll take the Neurotherm every time.

 

[ampaphb]

I have 3 stryker machines. Have used Cosman and Neurotherm as well. I do, indeed, flood the target with 5cc of lido mixed with marcaine. The Venom catheters have a portal 10mm proximal to the tip of the canula. I have found this to yield far less intra-procedural discomfort. I do use Versed to sedate these folks (after first localizing optimal needle position with both sensory and motpr stim).

 

[olafa]

Love my neurotherm- the 4th channel rarely used. I would get the warranty coverage, if the unit goes out they loan you a replacement and well worth it. The newer nitinol probes are great I have not any problems with it, I do 15-20 RF per week and stands up well. BTW they are now owned by St Jude, so you SCS St Jude rep is now covering neurotherm at least in my area. I typically use Boston for SCS so this was a little weird. But if you use St Jude they may have better pricing??

http://www.neurotherm.com/assets/electrodes_product_line.pdf

 

[ampaphb]

15 - 20 distinct rf patients per wk? Or 15 - 20 levels?

 

[powermd]

I have 3 stryker machines. Have used Cosman and Neurotherm as well. I do, indeed, flood the target with 5cc of lido mixed with marcaine. The Venom catheters have a portal 10mm proximal to the tip of the canula. I have found this to yield far less intra-procedural discomfort. I do use Versed to sedate these folks (after first localizing optimal needle position with both sensory and motpr stim).

5 mL is a lot of volume. So that's 20 mL over 4 targets? Do all of your patients leave the procedure suite dragging a leg?

I have NT 3 and 4-burners. We eat probes compared to you guys using Stryker, but then again we have 3 docs using the machine and multiple staff cleaning the probes. Way too easy to deny responsibility for a busted probe.

I put 1 mL lido 2% + some steroid on each site and wait 60-120 seconds before burning. I reserve 90-120 s waits for the really anxious and/or young patients with more robust anatomy. Seems to work well.

 

[Kwijibo]

We have 2 Neurotherm three lesion units and 3 Stryker units. Only keep the neurotherm to do Simplicity, which is no longer going to be covered by medicare. Neurotherm had all sorts of technical issues and they were really banging us out for the probes, which broke all the time. Machine stalling, probes not heating, timer not reaching, etc, etc.
Almost no problems at all with Stryker for 2 years.
However, now that Neurotherm was bought by St. Jude's, you may be able to get a good deal....

 

[olafa]

15 - 20 distinct rf patients per wk? Or 15 - 20 levels?

yes - I have many older patients with significant amounts of arthritis, I do two procedure days/week, every week is different sometimes lower numbers, higher esp Nov/Dec w end of year rush and on slower days maybe 5-6 RF and busier days 7--8 and occasionally 9, I have one carrier that is requiring b/l pain not to be staged to do together in one setting, so I count that as double. Maybe only one (more typical) or two per day no more. I still stage the cervical and thoracic and if patient want to do it their insurance wont cover it. I dont want to do bilateral cervical or thoracicSo average is closer to the 15 spectrum. I hope this answers your question, though I am not sure of the relevance to original post?

 

[bedrock]

Only keep the neurotherm to do Simplicity, which is no longer going to be covered by Medicare ...

What state are you in and you referring to a specific new global CMS rule for 2015?
I do 1 simplicity SIJ RF every 6 weeks, half on Medicare pts. I've never not been paid for a pt on regular Medicare.

 

[Ducttape]

the medicare guidelines i have seen all say that SI RF is experimental and not covered.

at least with CareCore National LCD (2015):

Sacroiliac joint denervation or neurolysis
A. By any method is considered investigational at this time

and what i could find from CMS website (2011):

Use CPT code 64999 (Unlisted procedure, nervous system) for pulsed radiofrequency and the denervation procedures of the sacro-iliac joint/nerves. Pulsed radiofrequency for denervation is considered investigational and therefore, not medically necessary. Sacro-iliac joint/nerve denervation procedures are also considered investigational and not medically necessary

 

[bedrock]

I appreciate the references. Medicare is big enough that they post different things in different places. They've paid for about 20 SIJ RF for me over the past 5 years , and haven't denied a single one.

This is kind of like going to the concert your parent probably won't approve of so you just go to the concert without asking permission.

From a clinical perspective, I've seen SIJ RF really help carefully selected pts so if CMS officially doesn't cover it, they are wrong medically speaking so screw them. I'm doing this to help people. It's not a big moneymaker, even after CMS pays the codes.

 

[olafa]

the medicare guidelines i have seen all say that SI RF is experimental and not covered.

at least with CareCore National LCD (2015):


and what i could find from CMS website (2011):

Is this standard to use 64999 for SIJ, how are others billing SIJ RF ? I do not use simplicity rather L5 dorsal ramus,and S1 S2 lateral br we have been billing other peripheral n, this is what our billers said is most reasonable to use.
And medicare covers in our area at least for now....

 

[Ducttape]

Pain Physician. 2009 May-Jun;12(3):665-70.

i dont know. my understanding is that all medicare claims are not reviewed upon payment, but all claims up to 3 years ago are open for retrospective review and possible refunding of claim requests...

 

[mike1br]

My practice is looking into purchasing a pre owned Cosman G4 RF generator, right now. Does anyone has , or know who has, one for sale ?

 

[myrandom2003]

If you do stim, Abbott/st jude may give you a “free” rf generator provided you use a certain number of their Scs and needles. I think needles cost 10-15.

Someone can correct me if I’m wrong or get better needle pricing.

Not sure if Boston/cosman do the same