SCS for vascular insufficiency

[bedrock]

I’m now practicing in a more rural area and running into some new patient populations. I know there is literature support to use SCS for pain from peripheral vascular disease and I’m considering offering it.

Naturally worried about the general health of such patients and implant infections.

My questions for the group are-

1- how tough is it to auth SCD for PVD? What codes do you use?
2- thoughts on best scs company for PVD?
3- Any pearls regarding who is worth the risk? I may just send all these implants to a local surgeon

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[BobBarker]

Check your Medicare lcd and see if it is in there. Most should have traditional Medicare so there is no auth process.

Implant them yourself. This is going to be a huge headache and the surgeon will catch on to what you are doing quickly.

 

[Ducttape]

I did a few.

1. they do not heal well. there is a reason they have PVD (ie smoking). and their circulation literally sucks.
2. the auth was not an issue as my LCD does cover for vascular, but definitely get a letter from your vascular surgery colleague when submitting.
3. the rural patients I see generally aren't that interested in stim or interventions. opioids seem to be a major request
4. best company was whichever gave most support, except cant use High frequency.

 

[Ferrismonk]

Never did it, but seems pretty straightforward from Evicore guidelines. I'd worry about anticoagulation/infection/etc

 

[Ronin1]

Piss poor protoplasm is major concern.

 

[SommeRiver]

Never done it and probably wouldn't do it either.

Question - Does SCS worsen venous insufficiency? If it increases blood flow would it be ill advised on pts with chronic LE edema? I have a few failed backs and they have the typical 1-2 + pitting edema and I've actually held off trying stim bc I'm concerned they may get a little more edema...Is that even a thing?

They're already infxn risks...

 

[bedrock]

I did a few.

1. they do not heal well. there is a reason they have PVD (ie smoking). and their circulation literally sucks.
2. the auth was not an issue as my LCD does cover for vascular, but definitely get a letter from your vascular surgery colleague when submitting.
3. the rural patients I see generally aren't that interested in stim or interventions. opioids seem to be a major request
4. best company was whichever gave most support, except cant use High frequency.

View attachment 319097

Thank you for your thoughts. Very good to know that nevro is out for this.

I'm also concerned about the protoplasm. Fortunately there is a neurosurgeon in denver that does lots and lots of stim. He even advertises himself as a limb salvage/ PVD specialists. They contacted me office to discuss a colloboration. I would be happy to trial these patients if he wants to implant them. He is going out of his way to market for that.

 

[lobelsteve]

I have several patients with vascular insufficiency that I haven’t planted. No issues with healing no issues with pain relief. They’ve all been evaluated by my local vascular surgeon and deemed non-operative well I’ve already had maximal operative care.