SI RFA

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
The lesion would be wider, assuming the tip deploys properly. You would still need to be cautious about spacing between the two Venom needles. Here are some nice images of the lesions geometry, and the second paper describes using Venom for bipolor lesioning of facet joints.


Bipolar Radiofrequency Facet Ablation of the Lumbar Facet Capsule: An Adjunct to Conventional Radiofrequency Ablation for Pain Management - PMC

Radiofrequency facet ablation (RFA) has been performed using the same technique for over 50 years. Except for variations in electrode size, tip shape, and change in radiofrequency (RF) stimulation parameters, using standard, pulsed, and cooled RF ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
 
I do bipolar strip lesions with nimbus needles for SIJ RFA. Have been doing so for years.
 
Orin said:
The lesion would be wider, assuming the tip deploys properly. You would still need to be cautious about spacing between the two Venom needles. Here are some nice images of the lesions geometry, and the second paper describes using Venom for bipolor lesioning of facet joints.


Bipolar Radiofrequency Facet Ablation of the Lumbar Facet Capsule: An Adjunct to Conventional Radiofrequency Ablation for Pain Management - PMC

Radiofrequency facet ablation (RFA) has been performed using the same technique for over 50 years. Except for variations in electrode size, tip shape, and change in radiofrequency (RF) stimulation parameters, using standard, pulsed, and cooled RF ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
Click to expand...

Thanks for the links. That second paper is trash, how could you be so lazy to write up a technique paper that does not show needles in ideal position, and on top of that the images are from a smartphone camera showing significant moire patterns. My god, if you are going to publish a technique paper, get some damn nice images in there at the least.

1610255574062.jpeg
 
RF cannula in the joint is odd to me. Capsular RF is reasonable but 1cc 6% phenol does the same thing in like 3 seconds.
 
Orin said:
The lesion would be wider, assuming the tip deploys properly. You would still need to be cautious about spacing between the two Venom needles. Here are some nice images of the lesions geometry, and the second paper describes using Venom for bipolor lesioning of facet joints.


Bipolar Radiofrequency Facet Ablation of the Lumbar Facet Capsule: An Adjunct to Conventional Radiofrequency Ablation for Pain Management - PMC

Radiofrequency facet ablation (RFA) has been performed using the same technique for over 50 years. Except for variations in electrode size, tip shape, and change in radiofrequency (RF) stimulation parameters, using standard, pulsed, and cooled RF ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
Click to expand...
Ablating the Lumbar Facet? Looks like a very interesting article. Thanks for sharing. It’s great to see innovative things like this. Curious how patient outcomes were long term.
 
Ligament said:
Thanks for the links. That second paper is trash, how could you be so lazy to write up a technique paper that does not show needles in ideal position, and on top of that the images are from a smartphone camera showing significant moire patterns. My god, if you are going to publish a technique paper, get some damn nice images in there at the least.

View attachment 327126
Click to expand...
maybe they thought that was ideal needle position... ?!
 
pmrmd said:
RF cannula in the joint is odd to me. Capsular RF is reasonable but 1cc 6% phenol does the same thing in like 3 seconds.
Click to expand...

does this pain come back, and what do you do next?

i would not personally RF the capsule but this has been proposed by many authors including as a way to treat C1-2 pain. (i'd personally not be included to sticking a RF probe there next to big red)
 
i do bipolar venom strip lesioning. I used to try to do it along the 3-6 oclock area lateral (if the right) to the posterior foramen S1 and S2 and then lateral to S3 like 1-3 o clock positioning as well as DR5 based on some dissection papers in Pain Medicine. since then I've gone to DR5 and and 5 bipolar strip lesion with venom from lateral to S1 to S3. i do 3 rounds moving the needles a bit in between. it takes a long time... but the outcomes are great.
 
oreosandsake said:
does this pain come back, and what do you do next?

i would not personally RF the capsule but this has been proposed by many authors including as a way to treat C1-2 pain. (i'd personally not be included to sticking a RF probe there next to big red)
Click to expand...
When it recurs I inject it again. Good for joints with huge osteophytes.
 
clubdeac said:
My results for SIJ RFA are the best of any of my RF procedures. It’s sad the new SIJ RF code pays so little
Click to expand...
pmrmd said:
I don’t believe that. C/L RFAs have such great results.
Click to expand...

Have to agree with PMRMD. I often have patients return from cervical/lumbar RFA with 80-90% relief. One can definitely achieve worthwhile results with SIJ RFA, but I don't think I've ever had a patient say they had 90% relief from a SIJ RFA. Usually in the 60-70% relief range (likely due to residual ventral SIJ innervation)

Agree that it is unfair how little the new SIJ RFA code pays, given the time involved to do it correctly, though it is better than the genicular RFA code which is downright insulting. If you do genicular RFA correctly with multiple lesions it takes about the same amount of time as does a L3-L5 unilateral RFA which pays around double the genicular payment.
I've recommended genicular RFA to friends and family in multiple states, and they often can't find anyone who will do their genicular RFA.........likely because it pays so poorly.
 
Last edited:
bedrock said:
Have to agree with PMRMD. I often have patients return from cervical/lumbar RFA with 80-90% relief. One can definitely achieve worthwhile results with SIJ RFA, but I don't think I've ever had a patient say they had 90% relief from a SIJ RFA. Usually in the 60-70% relief range (likely due to residual ventral SIJ innervation)

Agree that it is unfair how little the new SIJ RFA code pays, given the time involved to do it correctly, though it is better than the genicular RFA code which is downright insulting. If you do genicular RFA correctly with multiple lesions it takes about the same amount of time as does a L3-L5 unilateral RFA which pays around double the genicular payment.
I've recommended genicular RFA to friends and family in multiple states, and they often can't find anyone who will do their genicular RFA.........likely because it pays so poorly.
Click to expand...

Genicular RF was great as a one off when patients could cash pay at reasonable rates. How about we just call it prolotherapy and charge $750?
 
powermd said:
Genicular RF was great as a one off when patients could cash pay at reasonable rates. How about we just call it prolotherapy and charge $750?
Click to expand...
LOL. I actually don't mind that commerical insurances don't pay for SIJ/knee RFA as I just charge a reasonable cash price.
Unsure if I'm going to still offer it to medicare patients as the payment is not appropriate for the time spent and I'm already very busy
 
One would think a creative doc could legally get around the under-reimbursement dilemma somehow. I can think of soooo many ways... Here's one: $750 cup of coffee. Free RF.
 
64625.

be careful using it. this is an AMA code, and LCDs may not consider it a valid code. in my LCD, we have been expressly told that it is investigational and will not be covered just recently.
 
pmrmd said:
I don’t believe that. C/L RFAs have such great results.
Click to expand...
You're right I made that up....

Honestly though I think it's bc I use cooled for my SIJs and standard RF for my lumbar/cervicals. Larger needle and much larger lesion
 
Ducttape said:
64625.

be careful using it. this is an AMA code, and LCDs may not consider it a valid code. in my LCD, we have been expressly told that it is investigational and will not be covered just recently.
Click to expand...
Was that commercial insurance? I thought the consensus was that all insurances pay for the genicular/SIJ blocks, but only regular medicare will pay for the ablations.

Medicare advantage plans and commerical insurance plans don't pay for genicular/SIJ ablations, AFAIK.
 
Aside from Medicare - I do an rfa for “lumbosacral spondylosis”. Same as I did before the new code. Dx blocks to L4 mb, L5 dr /L5-s1 facet and bill accordingly. Then throw in the S1-3 on the house.
 
Taus said:
Aside from Medicare - I do an rfa for “lumbosacral spondylosis”. Same as I did before the new code. Dx blocks to L4 mb, L5 dr /L5-s1 facet and bill accordingly. Then throw in the S1-3 on the house.
Click to expand...
what do you mean aside from medicare?
 
bedrock said:
Was that commercial insurance? I thought the consensus was that all insurances pay for the genicular/SIJ blocks, but only regular medicare will pay for the ablations.

Medicare advantage plans and commerical insurance plans don't pay for genicular/SIJ ablations, AFAIK.
Click to expand...
that was the AMA code, not accepted by CMS.

I believe some commercial insurances did accept...

technically, medicare may "pay" for the blocks, but on retroactive review, will deem it investigational and may request refund.

Medicare advantage plans obviously follow the LCD, so that's why they wont pay beforehand.
 
You must log in or register to reply here.

Similar threads

C
Sacral Lateral Branch RFA (SI Joint) needle size?
Replies
17
Views
1K
cowboydoc
cowboydoc
J
Lumbar RFA Temperature
Replies
24
Views
2K
Taus
T
D
Testing for RFA
2
Replies
66
Views
3K
Ferrismonk
Ferrismonk
D
Lumbar RFA with VNS
Replies
9
Views
758
Orin
O
A
Medicare dropping 64624 (genicular RFA)?
Replies
33
Views
2K
BobBarker
BobBarker
Top