Scheduling MBB 2 weeks in between?

[CarabinerSD]

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It looks like Medicare requires a min of 2 weeks between MBBs trials. Is this the same for the PPO payors for your locality too?

 

[RM38]

in NC and SC yes it is

 

[Pain_doc]

most of them. It's easier for the staff to just remember to schedule the second set for everybody at least 2 weeks after the first.

 

[CarabinerSD]

Got it. It's annoying but I suppose better safe than not get reimbursed.

 

[thiswonthurtabit]

Some managed medicare reviewers will deny the second MBB if its REQUESTED too soon. Had to appeal (via letter cuz these chuckleheads don't allow P2P) because we generally do 2 day follow-ups for our MBBs and schedule the block 2 weeks after the first...they denied because we requested at 10 days after the first injection instead of 14...and we didn't even receive the denial until 15 days after the injection...

 

[sdnuser001]

I do two weeks for Medicare and one week for everything else

 

[Drd105]

Some managed medicare reviewers will deny the second MBB if its REQUESTED too soon. Had to appeal (via letter cuz these chuckleheads don't allow P2P) because we generally do 2 day follow-ups for our MBBs and schedule the block 2 weeks after the first...they denied because we requested at 10 days after the first injection instead of 14...and we didn't even receive the denial until 15 days after the injection...

Wowwww… is anyone else seeing this??

 

[justAstudent]

Can someone direct me to where this rule is?

 

[gaschicago]

A second diagnostic facet procedure is considered medically necessary to confirm validity of the initial diagnostic facet procedure when administered at the same level. The second diagnostic procedure may only be performed a minimum of 2 weeks after the initial diagnostic procedure. Clinical circumstances that necessitate an exception to the two-week duration may be considered on an individual basis and must be clearly documented in the medical record.

LCD - Facet Joint Interventions for Pain Management (L38803)

Use this page to view details for the Local Coverage Determination for Facet Joint Interventions for Pain Management.

www.cms.gov

 

[buddababa]

Wowwww… is anyone else seeing this??

yes me..midwest