RFA billing

[MD87]

In fellowship, I was told that you could bill at most for MBB or RFA either 4 nerves unilaterally or 3 nerves bilaterally. One of my co-workers told me that a bilateral RFA (in this case, C3-5) would not get paid. Is this true? What is your experience with this? FYI this patient was medicare.

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[Ligament]

Depends on the state too. Most insurers will heavily discount the contralateral side, so in essence you are getting ripped off for your work if you do bilateral. I don't know about medicare as opted out.

 

[DOctorJay]

You bill by joints treated not number of nerves burned


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[MD87]

Right. I billed 2 bilateral joints for c3, 4, 5 MBB. My question is if most insurances reimburse for this.


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[DOctorJay]

I agree with Lig that it's likely going to be state dependent. I know in my area we get 50% of the wRVUs for the second side for anything we do bilaterally. I only do unilateral when doing RFA for that reason.

 

[strike5858]

So I have a peer to peer coming regarding this. I did bilateral cervical mbbs + diagnostic. They approved bilateral 3 level rfa. Do I have to do this in one visit or can I split it up into two visits? I was unsure so I got my staff to get approval for each side independently and it was denied, hence the P2P that I will be doing.

 

[DubVille]

I generally try to do unilateral burns, then 2 weeks later contralateral. Do "worst side 1st" then tentatively schedule other side. Hasn't ever been an issue and I do BL diagnostics as you described. If its cervical there are some rare case reports about head drop doing BL RFA. You could use that for peer to peer

 

[thecentral09]

I generally try to do unilateral burns, then 2 weeks later contralateral. Do "worst side 1st" then tentatively schedule other side. Hasn't ever been an issue and I do BL diagnostics as you described. If its cervical there are some rare case reports about head drop doing BL RFA. You could use that for peer to peer

What could we use for same situation in low back?

 

[DubVille]

I'm not aware of any studies for lumbar in regards to weakness. I just dont like doing BL, takes me too long. I will sometimes do BL lumbars though if patient comes from far away, or is going on vacation, or has some reason to do both. This time of year everyone wants stuff before Jan 1st.

 

[HouseofPain]

Depends on state... where I’m at if doing unilateral can bill for 3 joints and if doing bilateral can only bill for 4 total. Also the patient is only allowed 2 total RF sessions per 12 months per spine region which means if you do one side and bring back for the other you can’t do anything until the 12 months is up

 

[MD87]

Depends on state... where I’m at if doing unilateral can bill for 3 joints and if doing bilateral can only bill for 4 total. Also the patient is only allowed 2 total RF sessions per 12 months per spine region which means if you do one side and bring back for the other you can’t do anything until the 12 months is up

Interesting. Can I ask what state you’re in? Is there some sort of resource where I can find what the policy is for my state? (Pennsylvania)


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[callmeanesthesia]

Interesting. Can I ask what state you’re in? Is there some sort of resource where I can find what the policy is for my state? (Pennsylvania)


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For Medicare, google “radiofrequency ablation Medicare LCD [state]”. For the private insurers some make their policies easy to google and some don’t.

 

[callmeanesthesia]

Am I the only one here who does 2 level bilateral as the default rather than making them come back for the other side? Maybe it’s the fact that I’m in one of the only cities for 3 hours in any direction, so probably a third of my patients are from at least an hour drive away. I place the needles for both sides at once in straight AP so it doesn’t take me twice as long as it does to do unilateral. For lumbar I just mark the SAP/TP junction in AP then mark a skin entry point 1-2 cm inferior lateral (depending on the size of the patient). Saves a lot of fiddling with the oblique angles, and all 6 needles can be placed at once.

 

[HouseofPain]

Interesting. Can I ask what state you’re in? Is there some sort of resource where I can find what the policy is for my state? (Pennsylvania)


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TN

 

[10KHertz]

Am I the only one here who does 2 level bilateral as the default rather than making them come back for the other side? Maybe it’s the fact that I’m in one of the only cities for 3 hours in any direction, so probably a third of my patients are from at least an hour drive away. I place the needles for both sides at once in straight AP so it doesn’t take me twice as long as it does to do unilateral. For lumbar I just mark the SAP/TP junction in AP then mark a skin entry point 1-2 cm inferior lateral (depending on the size of the patient). Saves a lot of fiddling with the oblique angles, and all 6 needles can be placed at once.

Right thing to do... good for you .

I see enough neuritis with cervical rfas that I prefer unilateral with Cervicals (esp @ C3). It avoids phone calls.

As for billing, the aforementioned comments are right, you are losing 50% of the fee schedule on the contralateral side with most commercial plans. That’s seems unjust , esp if you are still paying for your rfa machine .

 

[callmeanesthesia]

Right thing to do... good for you .

I see enough neuritis with cervical rfas that I prefer unilateral with Cervicals (esp @ C3). It avoids phone calls.

As for billing, the aforementioned comments are right, you are losing 50% of the fee schedule on the contralateral side with most commercial plans. That’s seems unjust , esp if you are still paying for your rfa machine .

Oh, I just tell people that 5-10% of patients get a bad sunburn feeling across the area and it can last for up to 4 weeks. That also usually avoids phone calls, unless it’s bad enough that I need to prescribe some gabapentin or something. I don’t remember the last tile I did. Mostly people just tell me about it at the follow up. Why not get the neuritis over with all in one sitting?

 

[paindoc007]

Oh, I just tell people that 5-10% of patients get a bad sunburn feeling across the area and it can last for up to 4 weeks. That also usually avoids phone calls, unless it’s bad enough that I need to prescribe some gabapentin or something. I don’t remember the last tile I did. Mostly people just tell me about it at the follow up. Why not get the neuritis over with all in one sitting?

You know the answer. People are doing the work, they want to get paid fairly. 50% for the contractural side sucks. So hence, one side at a time.

 

[Ronin1]

You know the answer. People are doing the work, they want to get paid fairly. 50% for the contractural side sucks. So hence, one side at a time.

Just transition to one side at a time. I usually tell them that we will do the worst side and then reevaluate. Often times only end up doing one side. Don’t work for free

 

[callmeanesthesia]

You know the answer. People are doing the work, they want to get paid fairly. 50% for the contractural side sucks. So hence, one side at a time.

I’m not sure it works out favorably for me. It doesn’t take me half as long to do one side, once you factor in prep and positioning, so it’s using at least 50% more time on my schedule to get paid 25% more of the overall total. However, I do most of mine in the office, and I’m not an ASC owner. Unless I’m mistaken, the ASC gets the same fee for a session whether it’s unilateral or bilateral, so they do lose out on 50% of the possible revenue when I do bilateral.

 

[lonelobo]

I’m not sure it works out favorably for me. It doesn’t take me half as long to do one side, once you factor in prep and positioning, so it’s using at least 50% more time on my schedule to get paid 25% more of the overall total. However, I do most of mine in the office, and I’m not an ASC owner. Unless I’m mistaken, the ASC gets the same fee for a session whether it’s unilateral or bilateral, so they do lose out on 50% of the possible revenue when I do bilateral.

no the payment dependent on the number performed

 

[10KHertz]

Oh, I just tell people that 5-10% of patients get a bad sunburn feeling across the area and it can last for up to 4 weeks. That also usually avoids phone calls, unless it’s bad enough that I need to prescribe some gabapentin or something. I don’t remember the last tile I did. Mostly people just tell me about it at the follow up. Why not get the neuritis over with all in one sitting?

Bilateral cervical neuritis can be debilitating for some patients, including ; insomnia , pain, loss of work time , etc. So for me not worth doing bilateral cervicals. Maybe my technique (lying as oblique as possible to MB nerve) causes this after effect .

 

[cowboydoc]

Am I the only one here who does 2 level bilateral as the default rather than making them come back for the other side? Maybe it’s the fact that I’m in one of the only cities for 3 hours in any direction, so probably a third of my patients are from at least an hour drive away. I place the needles for both sides at once in straight AP so it doesn’t take me twice as long as it does to do unilateral. For lumbar I just mark the SAP/TP junction in AP then mark a skin entry point 1-2 cm inferior lateral (depending on the size of the patient). Saves a lot of fiddling with the oblique angles, and all 6 needles can be placed at once.

I with you, I do bilateral lumbar all the time, and very rarely do bilateral cervical. The extra work to drop needles in contralateral side with no further setup or turnover is not terrible.

 

[MD87]

How do you do all 6 in AP at once? Doesn’t that make seeing which needle is which on the lateral difficult? Or do you check depth using CLO?


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[callmeanesthesia]

How do you do all 6 in AP at once? Doesn’t that make seeing which needle is which on the lateral difficult? Or do you check depth using CLO?


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Curved tip needles. Turn one side angle up, one side down. CLO in lower cervical to help confirm placement where the lateral is poor.