Therapeutic genicular blocks ?

[bedrock]

I have a patient who until recently was on commercial insurance. This covered genicular blocks but not ablations. So I did her blocks with dex and bup and she would get 6 months of relief each time, so we didn’t worry about a cash ablation.

She is now on Medicare. I’m happy to continue genicular blocks q 6 months and still postpone the ablation As long as Medicare is ok with this.

Anyone done repeated genicular blocks under Medicare and been paid each time?

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[kstarm]

any specific reason to choose dex in this case?

 

[Ferrismonk]

Medicare pays for RF, so you can do that if you wish.

As far as I know, Medicare doesn't say that the genicular blocks need to be without steroid, so I'd just add the steroid and see how it goes.

 

[lobelsteve]

any specific reason to choose dex in this case?

None. Why would anyone use dex anywhere besides TFESI?

 

[bedrock]

None. Why would anyone use dex anywhere besides TFESI?

Because it prolongs duration of blocks.

 

[Ducttape]

i think steve was talking about dex vs depo.

particularly since there are certain people who love depo in certain injections

 

[Ferrismonk]

None. Why would anyone use dex anywhere besides TFESI?

Cost can be a factor for those in private practice.

 

[bedrock]

Cost can be a factor for those in private practice.

True. Dex is damn cheap and good enough for prolonging a nerve block.

 

[MitchLevi]

I caused a substantial amount of fat necrosis 3ish years ago at the inframedial site. Prob the size of a quarter. Dex + 0.5% bupi.

 

[Agast]

As far as I know there is no local determination coverage for genicular nerve blocks, so there is nothing that compels you to do an RFA if you don’t want to

(Lack of LCD is why the replacement plans get away with not covering geniculars)

 

[oreosandsake]

I’d consider Revisiting your primary diagnosis

There are a lot of other structures in those areas

Pes anserine insertion
Infrapatellar saphenous n
Mcl

It’s tough for a nerve block to last that long. Not saying it doesn’t happen