SIJ Fusion vs Cluneal PNS?

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Taus said:
But they seem to work on LinkedIn…..
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LinkedIn is a alternate universe where every procedure is indicated for every problem, there are no contraindications, complications never occur and reimbursement is always generous.
 
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NJPAIN said:
LinkedIn is a alternate universe where every procedure is indicated for every problem, there are no contraindications, complications never occur and reimbursement is always generous.
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1635735172390.jpeg
 
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Hmm wonder who lobbied for that, lateral fusion companies or surgeons?
 
pmrmd said:
Dagger. Say adios to the reps from the dorsal fusion companies.
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They’ll modify their device just barely enough to be in compliance with this - or they’ll argue back with a reason as to why their product fits with the description of the CPT code.

They won’t go down without a fight (nor should they)
 
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gaspasser127 said:
They’ll modify their device just barely enough to be in compliance with this - or they’ll argue back with a reason as to why their product fits with the description of the CPT code.

They won’t go down without a fight (nor should they)
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I don’t see how they can modify into compliance without major change. Aurora has an implant coming with screws that may be modified into compliance but PainTeq/Omnia don’t have any way to cross the joint. I haven’t done CornerLoc so I can’t comment. If I were a rep for these I’d be out job hunting now.
 
Just to be clear - When the AMA clarifies a definition of a procedure, that definition becomes the law(?) is there a link to that decision I can use instead of a screen shot?
 
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NJPAIN said:
LinkedIn is a alternate universe where every procedure is indicated for every problem, there are no contraindications, complications never occur and reimbursement is always generous.
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only content on linkedin I've found any value in recently is from Eric Bricker, MD and Daniel Paull, MD
 
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Just talked to our reps for both PainTeq and CornerLoc and they both say the company line is that they’re safe because their studies show that their device specifically “transfixes” the SIJ.
 
Agast said:
Just to be clear - When the AMA clarifies a definition of a procedure, that definition becomes the law(?) is there a link to that decision I can use instead of a screen shot?
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The AMA writes the CPT code descriptions. The insurance companies pay for what the code describes.
 
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gaspasser127 said:
Just talked to our reps for both PainTeq and CornerLoc and they both say the company line is that they’re safe because their studies show that their device specifically “transfixes” the SIJ.
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But does it satisfy the part about crossing the sacroiliac joint?
 
Everyone is fighting in the gray areas to get their device or procedure covered.

The issue is the AMA CPT definition from 2015 for 27279. I don't think it has changed. My understanding is that the AMA example/definition argues for 27279 to be a device that is crossing the joint/engaging both bones which PainTeq/CornerLoc do, but also done with a minimally invasive lateral or trans-iliac approach.

It's a lot about documenting very precisely in the procedure note and hoping that the manufacturer is correct about the coding, but this is the hard part with new devices or approaches.
 
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Agast said:
But does it satisfy the part about crossing the sacroiliac joint?
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They said that the clinical example used which is what describes crossing the SIJ is just an example and that the only binding/required part of the code is transfixing the SIJ.

PainTeq guy sent me their biomechanical study which they said “provides evidence that the LinQ device transfixes the sacroiliac joint.”
 
I guess my question for these reps would be if not yours, then whose device are they describing that would default to 22899. I know I wouldn’t risk it in our ASC based on their biased interpretation. I’d let hospital-based folks be the Guinea pigs on that for awhile.
 
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gaspasser127 said:
Just talked to our reps for both PainTeq and CornerLoc and they both say the company line is that they’re safe because their studies show that their device specifically “transfixes” the SIJ.
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I’m sure they said that and are happy to do the case and give you the invoice for $8k but don’t expect a break or any help when the payment is denied.
 
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unchockey21 said:
I guess my question for these reps would be if not yours, then whose device are they describing that would default to 22899. I know I wouldn’t risk it in our ASC based on their biased interpretation. I’d let hospital-based folks be the Guinea pigs on that for awhile.
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Yeah great question… everyone’s gonna keep pointing the finger at the other company until they all get shut down. I’m curious to see how it plays out.
 
gaspasser127 said:
They said that the clinical example used which is what describes crossing the SIJ is just an example and that the only binding/required part of the code is transfixing the SIJ.

PainTeq guy sent me their biomechanical study which they said “provides evidence that the LinQ device transfixes the sacroiliac joint.”
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Ok, but that seems like a fancy way of saying No, it doesn’t. I mean the AMA basically went out of its way to say it doesn’t count, it’s not up to the device manufacturer to decide which part of the verbiage is “binding.”
 
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pmrmd said:
I don’t see how they can modify into compliance without major change. Aurora has an implant coming with screws that may be modified into compliance but PainTeq/Omnia don’t have any way to cross the joint. I haven’t done CornerLoc so I can’t comment. If I were a rep for these I’d be out job hunting now.
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Where were the pain doctors and pain societies? Asleep at the wheel? This happened on our watch.
 
I dont do these procedures but they all seem reverse engineered. Start with what you need to satisfy the billing then create the device. If it has meaningful clinical benefit that is a bonus.
 
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The latest from the AMA CPT KOL (coincidentally also a PainTeq KOL) is that what was posted is an opinion rather than an official CPT code change. What a S…t show.
 
NJPAIN said:
The latest from the AMA CPT KOL (coincidentally also a PainTeq KOL) is that what was posted is an opinion rather than an official CPT code change. What a S…t show.
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They’ll think differently when they get audited or worse for billing lots of these on Medicare patients….
 
pmrmd said:
I’m sure they said that and are happy to do the case and give you the invoice for $8k but don’t expect a break or any help when the payment is denied.
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They’re just worried they’ll have to go back to selling pain creams or genetic testing for rapid metabolizers….
 
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There's an overwhelming amount of cluneal neuralgia in my clinic. Nasty Dx that is gripping this nation.
 
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I feel like there’s an overwhelming amount of ass pain in general. We need better diagnostics and treatment that actually makes sense. One day there may be an “aha” moment but until then I hate when I see ass pain on my schedule
 
Dr. Ice said:
I feel like there’s an overwhelming amount of ass pain in general. We need better diagnostics and treatment that actually makes sense. One day there may be an “aha” moment but until then I hate when I see ass pain on my schedule
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I’ll take ass pain over chronic axial lbp that’s not from facets…
 
Taus said:
I’ll take ass pain over chronic axial lbp that’s not from facets…
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I guess that can be true..I can muck around with glut med/sij/proximal hamstring/dare I say piriformis a little until that gets exhausting also..

A few years ago there was an explosion of interspinous ligament pain with KOL prolo for chronic axial neck pain…that was fun to watch for awhile
 
I came here for peoples thoughts on cluneal PNS… a lot less invasive then fusion. Any good outcomes??
 
Dr. Ice said:
I guess that can be true..I can muck around with glut med/sij/proximal hamstring/dare I say piriformis a little until that gets exhausting also..

A few years ago there was an explosion of interspinous ligament pain with KOL prolo for chronic axial neck pain…that was fun to watch for awhile
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Ohhhh is that what that was? I had a patient who got “stem cell” treatments into his neck under fluoro but the way he described it I thought it was a row of trigger points down the middle of his neck. He paid $1000 to do it every 3 months.
 
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