MILD : Stent

[gaspasser127]

I recently created a LinkedIn account and started following some pain docs, KOLs, companies etc.

Anyway, some of the stuff I’ve seen has been eye opening (not in a good way)

Here’s an ad/post by Vertos.

I’m not quite sure I would describe MILD as a stent - there’s no similarity between the two….

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Members don't see this ad.

 

[MitchLevi]

I've always been worried about L4-5 cord compression.

 

[RoloTomassi]

Bad analogy but probably just targeting his Medicare clientele who have had multiple lifesaving stents.

 

[Agast]

I describe the ligamentum flavum as like a melon rind that’s thickening behind your spinal canal and when you scrape it off it’s like taking feathers out of an overstuffed pillow so more space is created.

 

[deleted875186]

I would probably just show them a single axial t2 cut through the level ….. I think even a kindergarten student could appreciate the ligament after pointing it out.

 

[Dr. Ice]

I would probably just show them a single axial t2 cut through the level ….. I think even a kindergarten student could appreciate the ligament after pointing it out.

Kindergarteners have more active brain cells..if someone can’t understand medial branch blocks/rfa after pictograms, how could they really understand anything

 

[ateria radicularis magna]

Kindergarteners have more active brain cells..if someone can’t understand medial branch blocks/rfa after pictograms, how could they really understand anything

Understand anything lol!

 

[MitchLevi]

I want to understand how to get paid for the cases I've already done...

 

[Agast]

I want to understand how to get paid for the cases I've already done...

Payment pending or payment denied?

 

[MitchLevi]

Payment pending or payment denied?

Both.

 

[Sig123]

Both.

They are definitely tricky to get paid and require very specific details on the claim.

Have your billers reach out to the Vertos reimbursement team. They were very helpful to my billing team for some of these claims.

 

[RoloTomassi]

Both.

Medicare or commercial?

 

[Ducttape]

focus on Medicare.

every private insurance i have tried to get prior auth has denied.

 

[Agast]

Both.

Have done two so far. Primary Medicare, paid $930 after about 2 weeks. The other was a UH advantage plan on 2/03 that is still pending, they told my biller they have 60 days to process the claim…

 

[MitchLevi]

Have done two so far. Primary Medicare, paid $930 after about 2 weeks. The other was a UH advantage plan on 2/03 that is still pending, they told my biller they have 60 days to process the claim…

Medicare. Did one in November and December. Yet to be paid. We have been in touch with Vertos the entire time.

I refuse to do another. Ever.

 

[myrandom2003]

what is the wrvu value for mild?

edit:
Nevermind. found my answer from the mILD website:
Category III CPT codes do not have assigned relative value units (RVUs) for calculation of physician payment; the physician payment will be contractor-adjusted by each Medicare Administrative Contractor (MAC). It is recommended that you contact your local MAC to determine specific payment levels in your area.

 

[bedrock]

Medicare. Did one in November and December. Yet to be paid. We have been in touch with Vertos the entire time.

I refuse to do another. Ever.

primary straight medicare (not advantage plan)?

If so, then it is odd that agast was paid and you were not

 

[MitchLevi]

primary straight medicare (not advantage plan)?

If so, then it is odd that agast was paid and you were not

Medicare, and don't know off the top of my head all of the details. I've had 1M emails with multiple reasons as to why we've not been paid. First, our people submitted something like a O instead of 0 or vice versa, then it's this, then that...I just emailed again for updates and we're submitting through our clearing house but can't get the T number added onto the bill...

I'll never do another MILD case.

I've done two, one in Nov and one in Dec.

 

[RoloTomassi]

Do the MILD KOLs who crank these out get Medicare reimbursement or do they just get paid by the company / comped kits?

 

[MitchLevi]

Do the MILD KOLs who crank these out get Medicare reimbursement or do they just get paid by the company / comped kits?

Very good Q.

It seems there are tons of MILD cases taking place in this country and surely I'm not the only one who isn't getting paid for them.

 

[Dr. Ice]

focus on Medicare.

every private insurance i have tried to get prior auth has denied.

You will do MILD, with quite questionable outcomes, but you will take every chance you get to bash regen..have you ever even tried it or offered it to patients? Or is the lack of “level 1 evidence” also conveniently argumentative based on your own practice set up and demographics which wouldn’t allow you to offer it? What if epidural lysate was available to your demographics without them having to shell out some cash? Would you be so quick to shoot down all the articles that drusso posts?

MILD has some nice industry backing..or so I’m told

Even the best of us need to look into a broken mirror at times, because the broken mirror gives us a reflection of what we may not want to see

 

[Ducttape]

Medicare, and don't know off the top of my head all of the details. I've had 1M emails with multiple reasons as to why we've not been paid. First, our people submitted something like a O instead of 0 or vice versa, then it's this, then that...I just emailed again for updates and we're submitting through our clearing house but can't get the T number added onto the bill...

I'll never do another MILD case.

I've done two, one in Nov and one in Dec.

this sounds like an in house issue, not a Medicare issue...

You will do MILD, with quite questionable outcomes, but you will take every chance you get to bash regen..have you ever even tried it or offered it to patients? Or is the lack of “level 1 evidence” also conveniently argumentative based on your own practice set up and demographics which wouldn’t allow you to offer it? What if epidural lysate was available to your demographics without them having to shell out some cash? Would you be so quick to shoot down all the articles that drusso posts?

MILD has some nice industry backing..or so I’m told

Even the best of us need to look into a broken mirror at times, because the broken mirror gives us a reflection of what we may not want to see

sounds like someone is trying to pick a fight because his feelings got hurt...


there is better science at present for MILD than there is for PRP of the spine. remember that the way MILD was studied initially was different than other new interventional spine procedures. it has been around for 10 years. and yes, Vertos has funded the studies. MILD in my mind is useful if multiple preconditions are met - failed ESI, failed PT, failed standard meds, severe ligamentous hypertrophy, seen by spine surgeon who refused to perform surgery or has comorbidities that make surgery unfavorable.


outside of the spine, i want to see quality data that shows that PRP is both safe and effective.

i dont do PRP for a variety of reasons. but ive stopped doing tendon and epicondylitis steroid injections and over 50% of knee injections. instead i lose money by telling these patients who to go and giving them a referral. when a PCP calls and asks, i send these patients elsewhere. the only knees i do are on patients that cant afford PRP.

im quick to shout out anything that doesnt have good evidence of work.


i am willing to bet i have stared longer at that broken mirror, continuing your analogy, than anyone else on this forum. remember that unless you look at it, you will not notice its flaws.

 

[drusso]

You will do MILD, with quite questionable outcomes, but you will take every chance you get to bash regen..have you ever even tried it or offered it to patients? Or is the lack of “level 1 evidence” also conveniently argumentative based on your own practice set up and demographics which wouldn’t allow you to offer it? What if epidural lysate was available to your demographics without them having to shell out some cash? Would you be so quick to shoot down all the articles that drusso posts?

MILD has some nice industry backing..or so I’m told

Even the best of us need to look into a broken mirror at times, because the broken mirror gives us a reflection of what we may not want to see

Excellent points.