Hardware block billing

[bedrock]

Local surgeon requested a hardware block of L4-S1 fusion.

Been a while and I’m wondering about billing.

He wants me to block all six screw points

Seems like more than a TPI, actually close to an MBB.

Debating how to auth and what to bill for this?

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[SSdoc33]

Local surgeon requested a hardware block of L4-S1 fusion.

Been a while and I’m wondering about billing.

He wants me to block all six screw points

Seems like more than a TPI, actually close to an MBB.

Debating how to auth and what to bill for this?

Do the screws come out if the patient feels better?

the good news is that you can actually see the MBBs once the hardware is removed and the patient is still in pain

it is a TPI + 77002/3

 

[MitchLevi]

WTF is a hardware block?

You inject local at the site of pedicle screw entry into the bone?

What does that tell you?

 

[Baron Samedi]

Yeah I would be extremely cautious about making surgical decisions based on the results of a hardware block. If there's no obvious lucency around the screws or a fracture, that probably isn't the issue.

Put in leads and go for steaks. Just kidding. But not really.

 

[Agast]

Well, MBB is out because you’re very specifically at a fused level.

Maybe you could call it an intermediate branch block and make a case for blocking pain to the longissimus muscle, and bill as peripheral nerve block?

 

[Ferrismonk]

Hardware blocks are old-school. Is the surgeon and old-school surgeon?

Not a MBB and it's considered inappropriate to bill as such. The correct billing is a TPI + fluoro, although I agree that's not reflective of the skill or risk.

And I agree that surgical management should not be based on hardware blocks.

 

[bedrock]

Thank you everyone. I haven’t done this in years.
Is a specific request from an out of state surgeon.

 

[Baron Samedi]

Thank you everyone. I haven’t done this in years.
Is a specific request from an out of state surgeon.

Sooo not someone you rely on for future referrals?

 

[RoloTomassi]

I wouldn't do it. I'm super paranoid about biofilms, infection, never touch needle to hardware.

 

[bedrock]

I wouldn't do it. I'm super paranoid about biofilms, infection, never touch needle to hardware.

Sooo not someone you rely on for future referrals?

Hm. Definitely food for thought.

 

[lobelsteve]

I wouldn't do it. I'm super paranoid about biofilms, infection, never touch needle to hardware.

Lick it and stick it you baby.

 

[Orin]

Just do the needle through needle technique and call it a day...

Seriously though, I don't mind doing them but it's rarely ever asked. If I'm worried, oral or IV abx should reduce the risk.

Ultrasound or fluoro to make sure you touch hardware.

In the case of painful pedicle screws, I sometimes suspect it's a vertebral body pain so I might offer basivertebral ablation if there's corresponding imaging suggesting bony issues.

I suspect though they're hoping your injection is negative as taking fusion hardware out sucks

 

[10KHertz]

Neuroma injection ?
Paravertebral block-NOS?

64450?