Vertebroplasty

[C Fiber]

Why aren't more pain docs doing vertebroplasties? What is the cost?

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[PainFellow]

I don't know the answer to your question, but we routinely do them. In fact, I did one last week...with excellent results. From my limited experience (during interviews) most programs don't do them. I'm not sure why, because it's a fairly simple proceedure.

 

[lobelsteve]

I don't know the answer to your question, but we routinely do them. In fact, I did one last week...with excellent results. From my limited experience (during interviews) most programs don't do them. I'm not sure why, because it's a fairly simple proceedure.

We did a few. Our fellowship wasn't set up for doing them in large volumes, we just did not have the time and more importantly, the marketing to get the referrals in a timely fashion from FX to injection.

 

[Doctodd]

You might have a turf war with IR docs...equipment is too expensive(~$4000) to do in private offices, but you could do it at an ASC or local hospital....but at a hospital you again have the turf war problem.


T

 

[lobelsteve]

You might have a turf war with IR docs...equipment is too expensive(~$4000) to do in private offices, but you could do it at an ASC or local hospital....but at a hospital you again have the turf war problem.


T

What equipment? I think we all have fluoro available. The Stryker kit we used was not billed out through our office but approved separately through a third part administator for this purpose.

 

[PainFellow]

I think I know the answer...or at least one explanation. I was recently informed that this proceedure should NEVER be done without neurosurg backup (which we always have). Very rarely, the cement can leak and cause cord compression. According to my attending there have been about 15 such cases that he's aware of (nation wide). If this occurs, IMMEDIATE neurosurgical intervention can reverse the compression. According to my source, those cases that received immediate intervention experienced complete recovery, while those that didn't, experienced partial to complete paralysis.

 

[Aether2000]

Neurosurgeons are available in hospital settings with or without pre-arranged "backup". Interventional radiologists have not had such pre-arranged "backup" for a rare complication. Family docs do not need general surgeon backup for the rare sigmoidoscopy complication of perforation. At some point, pain physicians must realistically assess the relative risk of a procedure, the urgency of having immediate surgical intervention (not so for cement leakage since the patient will have an MRI and other diagnostics anyway prior to any such intervention), and other factors before deciding on a location for a particular procedure. ASC or office vertebroplasty is becoming far more common now and for good reason given the relative safety of the procedure.

 

[drrinoo]

Some radiologists have free standing imaging centers, where they can do procedures, such as vertebroplasty or discography. These are typically practitioner owned facilities and not within a hospital-setting.

 

[drrinoo]

What equipment? I think we all have fluoro available. The Stryker kit we used was not billed out through our office but approved separately through a third part administator for this purpose.

This is curious...the only way this could happen is if Stryker products are classified as durable medical equipment...which can be billed separately.

However, my understanding is with most medical devices...they cannot be classified as DME if used to perform a procedure. Rather, the lump sum payment by Medicare is for the total costs incurred by the practitioner.

However, I have heard that ANS devices can be billed as DME, but I have not confirmed this....

As for the 4000 dollars....that is the Medicare reimbursement per level in an office or ASC...hence, practitioners do these in their offices...if performed in a hospital, the physician just gets the professional component...?300 to 400 dollars...off hand, I don't know how additional levels are billed, whether 1/2 for each addl level or 1/2 the professional component for all addl levels (whether you do one addl or 3-4 addl (e.g., in osteogenesis imperfecta).