New Cat 1 Code for Dorsal SIJ Fusion

[drusso]

Now, more than ever, we need options for patients suffering from disabling and incapacitating SIJ pain. Office-based SIJ ablations are experimental and HOPD-based fusions are fool-proof.

AMA Announces Category 1 Billing Code for Posterior SI Joint Fusion

/PRNewswire/ -- The American Medical Association (AMA) has announced a new Category 1 billing code specifically for posterior SI joint fusion, including...

www.prnewswire.com

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[Agast]

The special code means it will now be easily rejected as experimental by private insurance.

 

[lobelsteve]

Now, more than ever, we need options for patients suffering from disabling and incapacitating SIJ pain. Office-based SIJ ablations are experimental and HOPD-based fusions are fool-proof.

AMA Announces Category 1 Billing Code for Posterior SI Joint Fusion

/PRNewswire/ -- The American Medical Association (AMA) has announced a new Category 1 billing code specifically for posterior SI joint fusion, including...

www.prnewswire.com

SIJ pain is never disabling nor incapacitating. I will make exceptions for Fx across the joint or AS/cancer.

 

[Dr. Ice]

Ass pain has a wide differential, in my opinion one of the most frustrating entities to #1) diagnose and #2) treat

 

[Tboned]

A** pain is easy, cluneal nerve or SIJ joint. Ablate or fuse. WIN-WIN

 

[MitchLevi]

I've seen SCS for SIJ pain. Clear SIJ pain misdiagnosed by outside pain physicians.

 

[lobelsteve]

I've seen SCS for SIJ pain. Clear SIJ pain misdiagnosed by outside pain physicians.

Misdiagnosis, or intentional to allow for lucrative interventional care?

 

[Taus]

A** pain is easy, cluneal nerve or SIJ joint. Ablate or fuse. WIN-WIN

You forget pns…. Trifecta

 

[swamprat]

Misdiagnosis, or intentional to allow for lucrative interventional care?

Lobel it really doesn't pay much from professional fee standpoint. I guess if you on ur ASC but when i do posterior SI arthrodesis I'm getting between 500-750/800 depending payor. Far from a homerun. Much rather do in office stim or kypho or MM lol - ancedotally I do feel this works well in the right patient - must have successful pain relief for duration of anesthestic after SI joint injection.

 

[lobelsteve]

What percentage of patients do we see actual have SIJ pain?

What percentage of patients do we see that have SIJ pain that fail PT/topical nsaids?

What percentage of those patients fail SIJ inj? Then fail SIJ RF?

1 in a thousand of my patients fit this category. Not enough to determine if a next step is needed or if it would work.

 

[oreosandsake]

Microdosing ITT for refractory pain…

 

[lobelsteve]

Microdosing ITT for refractory pain…

Doesn’t count against MEQ

 

[MitchLevi]

must have successful pain relief for duration of anesthestic after SI joint injection.

...that tells you nothing.

 

[Magnus Acus]

What percentage of patients do we see actual have SIJ pain?

What percentage of patients do we see that have SIJ pain that fail PT/topical nsaids?

What percentage of those patients fail SIJ inj? Then fail SIJ RF?

1 in a thousand of my patients fit this category. Not enough to determine if a next step is needed or if it would work.

Do you really only have that few that don’t get SI relief with that algorithm?

 

[oreosandsake]

I know lot of folks don’t really believe it’s SIJ…. But it’s top 10 diagnosis in my practice. I’m not so confident about cluneal and other exotica and I don’t fuse. But lateral branch rfa has done wonders for my patients. Bipolar 18G venom 5 needles based on the Stout paper and Burnham papers that came out 3-6 years ago in pain medicine journal.

 

[lobelsteve]

Do you really only have that few that don’t get SI relief with that algorithm?

Yes. Dx based on 2/3 exam maneuvers and FGCI IA SIJ inj.

 

[deleted131481]

SIJ is not an uncommon diagnosis in my practice. I rarely see it debilitating, especially in the motivated patient doing PT. A good amount respond to IA or RFTC and if that's not enough I stop and say they have to learn to manage it - it's not keeping any of my patients from working who want to.

 

[MitchLevi]

SIJ CSI, RFA or PRP works.

RFA isn't great, but some do okay with it.

 

[swamprat]

...that tells you nothing.

How so? If intra-articular and 1-2 cc 0.5% bupivacaine injected into joint and they have pain relief where is the pain generator?

 

[MitchLevi]

How so? If intra-articular and 1-2 cc 0.5% bupivacaine injected into joint and they have pain relief where is the pain generator?

I find SIJ pain far more complicated than that.

Pain is an emotional experience by definition, and the idea an anesthetic test dose means anything of value is way too simple IMO.

These same pts...You chase that local with a CSI or no?

 

[swamprat]

I find SIJ pain far more complicated than that.

Pain is an emotional experience by definition, and the idea an anesthetic test dose means anything of value is way too simple IMO.

These same pts...You chase that local with a CSI or no?

I'm sorry CSI?

And yes all pain there is a supratentorial component for sure I'm just saying anecdotally it has been really successful for my patients

 

[Ducttape]

CSI = corticosteroid injection

 

[RoloTomassi]

I'm open minded to SI fusion as a last resort, but rarely see candidates. Again, because most SI area pain is radic/facet/disc/endplate, and if actually SI, responds to steroid/PRP/RFA.

I think intraarticular anesthetic injection with minimal skin local has diagnostic value. I do differential intraarticular hip blocks. Not that different from MBB either

 

[Doctodd]

I have a couple lumbar fusion patients who get 3-6m relief from PRP carpet bombing of SIJ and ligaments and a couple other areas including epidurally. And yes they have failed everything else. For $500 it’s worth it to them.

 

[Agast]

I have a couple lumbar fusion patients who get 3-6m relief from PRP carpet bombing of SIJ and ligaments and a couple other areas including epidurally. And yes they have failed everything else. For $500 it’s worth it to them.

$500 is a great price for a PRP injection - is that how much you’re charging total?

 

[swamprat]

I have a couple lumbar fusion patients who get 3-6m relief from PRP carpet bombing of SIJ and ligaments and a couple other areas including epidurally. And yes they have failed everything else. For $500 it’s worth it to them.

Can you tell me what "company" or whatever you use for PRP? I'm interested in this but never was approached by any reps or anything. 500 isnt bad I bet some of my patients who failed everyhing else would possibly be OK doing this.

 

[Doctodd]

I don’t use kits anymore, but Emcyte was who I started with….yes $500 for established patients

 

[Ducttape]

personally, id think it more reasonable to do PRP than SI fusion - there seems to be more data to support PRP.

 

[SageCraft]

I've had PRP for my SIJ twice. First injection gave me 6 months of relief. Second injection involved more of a "carpet bombing" technique and has given me 2.5 years of relief. It hasn't eliminated my underlying dysfunction, but has certainly allowed me to be more physically active than I was 5 years ago.

 

[drusso]

Lobel it really doesn't pay much from professional fee standpoint. I guess if you on ur ASC but when i do posterior SI arthrodesis I'm getting between 500-750/800 depending payor. Far from a homerun. Much rather do in office stim or kypho or MM lol - ancedotally I do feel this works well in the right patient - must have successful pain relief for duration of anesthestic after SI joint injection.

These procedures' purpose/pricing model is to drive reimbursement to the facility. The vig on the SOS is to the facility, not the doctor. The best scenario is to be on BOTH sides of the deal--the menial pro fee and the juicy facility. That's how the magic happens.

 

[lobelsteve]

Solving the epidemic, one or two patients at a time.

 

[Espn123]

I find SIJ pain far more complicated than that.

Pain is an emotional experience by definition, and the idea an anesthetic test dose means anything of value is way too simple IMO.

These same pts...You chase that local with a CSI or no?

So you don’t do medial branch blocks?

 

[MitchLevi]

So you don’t do medial branch blocks?

I don't equate the SIJ with the facet.

 

[Dr. Ice]

Solving the epidemic, one or two patients at a time.

Look at that ridiculous screw in there 🤦🏽‍♂️

 

[SpineandWine]

Aren’t there certain posterior SI fusions that are still covered? (Cornel loc, etc). Also, what’s preventing one from doing lateral fusion with Rialto (medtronic).

Just wondering as I am trying to navigate around this

 

[soccrwz]

Aren’t there certain posterior SI fusions that are still covered? (Cornel loc, etc). Also, what’s preventing one from doing lateral fusion with Rialto (medtronic).

Just wondering as I am trying to navigate around this

Rialto is a posterolateral fusion

 

[SpineandWine]

Rialto is a posterolateral fusion

So is it a T-code for 2023?

 

[BobBarker]

Rialto is fine. 27279

 

[Espn123]

Waiting for T code reimbursement on my first few posterior fusion cases of 2023

 

[BobBarker]

You might get $0. I think that is most likely.

Vyrsa V1, Sacrix, Rialto, New cornerloc
Or a true lateral are the only options

 

[Espn123]

You might get $0. I think that is most likely.

Vyrsa V1, Sacrix, Rialto, New cornerloc
Or a true lateral are the only options

T codes usually don’t reimburse zero. We’ll see, happy to share when I find out

 

[soccrwz]

So is it a T-code for 2023?

I don't believe so since it transfixes the joint, sacrix would be a similar device

 

[Espn123]

I don't believe so since it transfixes the joint, sacrix would be a similar device

I believe anything that transfixes the joint will still be 27279

 

[PinchandBurn]

T codes usually don’t reimburse zero. We’ll see, happy to share when I find out

T code for mild Does reimburse. Does anybody know what the t code for this does

 

[PinchandBurn]

Waiting for T code reimbursement on my first few posterior fusion cases of 2023

Let us know!

Lateral is now 17k facility.. curios WHT T code posterior is

 

[BobBarker]

It says $0 from every source I have seen.

 

[BobBarker]

T code is the same as lateral or posteriolateral for the facility. Lot of money.

 

[Norepi]

I've seen SCS for SIJ pain. Clear SIJ pain misdiagnosed by outside pain physicians.

In these people who clearly do well with SIJ diagnostic injection but fail RFA, no centrifuge around or no relief with PRP, what is the argument against trying dorsal column stim? If it has some data for failed back, why wouldn't chronic SIJ pain respond also? Would we all honestly even think about a fusion in that case over something we have more experience with as a field? Just food for thought.

 

[RoloTomassi]

In these people who clearly do well with SIJ diagnostic injection but fail RFA, no centrifuge around or no relief with PRP, what is the argument against trying dorsal column stim? If it has some data for failed back, why wouldn't chronic SIJ pain respond also? Would we all honestly even think about a fusion in that case over something we have more experience with as a field? Just food for thought.

No data for OA of facets, hips, knees... What makes you think it'd work for OA of SIJ?

 

[MitchLevi]

In these people who clearly do well with SIJ diagnostic injection but fail RFA, no centrifuge around or no relief with PRP, what is the argument against trying dorsal column stim? If it has some data for failed back, why wouldn't chronic SIJ pain respond also? Would we all honestly even think about a fusion in that case over something we have more experience with as a field? Just food for thought.

Sorry, there's no food for thought here.

SI laxity or sclerosis of the joint. OA...

By the very MOA of SCS, there is no role for stimulation.

The thought process you’re detailing is what leads to overuse and subsequent payer scrutiny. Eventually the treatment goes away.