Interesting clawback from Humana
Got a "refund request" from our good friends at Humana today. Clawing back two 99204s and one 99214 because "diagnosis code(s) are inappropriate". The only code all three charts have in common is G894 chronic pain syndrome. None of them use it as a primary or even secondary diagnosis, but as a 3rd or 5th diagnosis. Just a heads up don't use that code at all for Humana pts. (Source: Student Doctor Network)
Source: Student Doctor Network - April 19, 2024 Category: Universities & Medical Training Authors: drrosenrosen Tags: Pain Medicine Source Type: forums
NASS vs ACGME Fellowships: Which Makes a Better Doctor in Real World?
ISMM Fellowships
The primary focus of NASS-recognized ISMM fellowships is the clinical assessment and treatment of patients with spine and musculoskeletal conditions. The fellowships are unique from ACGME Pain Medicine fellowships, which require training in inpatient acute pain management, palliative care, psychiatry, pediatric pain management, and intubation. (Source: Student Doctor Network)
Source: Student Doctor Network - April 14, 2024 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums
SCS doesn ’t work?
Evidence doesn’t support spinal cord stimulators for chronic back pain – and they could cause harm
A recent Four Corners episode questioned the use of surgically implanted devices called spinal cord stimulators for chronic back pain. Here’s what the evidence says.
theconversation.com (Source: Student Doctor Network)
Source: Student Doctor Network - April 12, 2024 Category: Universities & Medical Training Authors: lobelsteve Tags: Pain Medicine Source Type: forums
Repeat lumbar RFA time restrictions
I’ve been told and read in a few LCDs , but not all, that a patient needs repeat their RFA within 2 years or insurance won’t cover it.
So if a patient comes back after 3 years, they have to repeat MBB to ensure insurance will cover it.
Obviously If they have spine surgery in between, they need to repeat MBB.
But for folks at 2.5 years , 3.5 years post PFA, who did well for +2 years after RFA, how do you all handle this? (Source: Student Doctor Network)
Source: Student Doctor Network - April 3, 2024 Category: Universities & Medical Training Authors: bedrock Tags: Pain Medicine Source Type: forums
VA occlusion
Have a patient with moderate cervical stenosis and clear radicular pain. Had planned to do a CESI.
His c spine MRI and later CT angiogram revealed a major blockage of the entire left VA as it passes through the neck.
He didn’t have any CN deficits when I saw him last month.
Thoughts on him ? No acute neurological deficits so I was thinking of sending him to neurology but they have a 2 month wait.
Maybe just send him to ER in major city so he can get a same day neurology consult? (Source: Student Doctor Network)
Source: Student Doctor Network - March 20, 2024 Category: Universities & Medical Training Authors: bedrock Tags: Pain Medicine Source Type: forums
RIP Greg Lutz, MD
We say Goodbye to a pioneer and leader in interventional spine, pain, and regenerative medicine.
HSS Doctors: Book an Appointment Online Today (Source: Student Doctor Network)
Source: Student Doctor Network - March 12, 2024 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums
WEBINAR: Early Career Spine Professionals - Working with Multidisciplinary Colleagues
Presented by the North American Spine Society (NASS)
This webinar is designed to enhance your collaborative skills and effectiveness in a multidisciplinary healthcare setting. In today's dynamic medical landscape, successful patient outcomes often rely on seamless cooperation and communication among diverse specialists. Whether you're involved in Medical and Interventional Spine Practice, Ketamine and Chronic/Comprehensive Pain Practice, or Surgical Spine Practice...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - March 8, 2024 Category: Universities & Medical Training Authors: NASS Tags: Nonprofit / Educational / Student Orgs Source Type: forums
MBB/RFA approval after fusion?
I have a patient that is fused extensively from mid thoracic to pelvis due to severe scoliosis and DDD. Imaging does not show any significant disc herniation or stenosis, and doesn't have radicular symptoms. His pain is mostly mechanical & axial, and TPI helps for a short amount of time. I'm thinking back about my training days where some patients did get some relief with MBB/RFA despite having had lumbar fusion. However I've read that some insurances will not allow MBB post-fusion (patient...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - March 6, 2024 Category: Universities & Medical Training Authors: CarabinerSD Tags: Pain Medicine Source Type: forums
USAF HPSP pitfalls
After spending 13 years enlisted, 8 of it AD, in aviation maintenance I entered a US MD program on an HPSP scholarship. During April of my second year I was diagnosed with NHL after presenting with back pain and pending paraplegia. I underwent an emergent laminectomy followed by EBRT and chemotherapy. January of my fourth year I was notified that my scholarship was being terminated for being unfit to serve. I was never allowed to meet a medical board. I graduated with my class and completed...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - February 17, 2024 Category: Universities & Medical Training Authors: MT Doc Tags: Military Medicine Source Type: forums
Guam as Civilian Physician Spouse
Reaching out for advice/leads/help as civilian physician spouse hoping to practice interventional pain/sports/spine in Guam. Wife and I are PCSing late September. Appreciate any help in advance! (Source: Student Doctor Network)
Source: Student Doctor Network - February 8, 2024 Category: Universities & Medical Training Authors: poppinfresh123 Tags: Military Medicine Source Type: forums
PRP spine …?
I have a tricare patient with facet mediated lumbar pain, wants PRP for the discs. Can anyone advise me of a few phsyicians doing this procedure regularly to make my life easier when someone is determined to have it done? (Source: Student Doctor Network)
Source: Student Doctor Network - February 2, 2024 Category: Universities & Medical Training Authors: Drd105 Tags: Pain Medicine Source Type: forums
SCS trials in office (oral sedation/antibiotics)
Due to limited OR availability, will be doing SCS trials in office. Outside of localizing the tract with a 25g spinal needle (0.25% marcaine : 1% lidocaine mix) prior to the Tuohy needle, what PO meds do you guys use for sedation? Was thinking potentially 5-10mg valium, and a 5mg percocet.
For antibiotics, doing an IV won't be logistically smooth. Heard about potentially being able to do PO antibiotics before/during trial, instead of the IV ancef. Any recs there? (Source: Student Doctor Network)
Source: Student Doctor Network - February 1, 2024 Category: Universities & Medical Training Authors: SgtThunderfistMD Tags: Pain Medicine Source Type: forums
SCS for depression being studied
The Spinal Cord Could Provide a Radical New Way to Treat Depression
With depression affecting around 1 in 10 of us at some point during our lives, the need for new and improved treatments is a top priority for researchers – and it appears that spinal cord stimulation could be one route for experts to investigate.
www.sciencealert.com (Source: Student Doctor Network)
Source: Student Doctor Network - January 13, 2024 Category: Universities & Medical Training Authors: lobelsteve Tags: Pain Medicine Source Type: forums
Another Assistance with Job Offer Thread
New grad here trying to toggle through my various job offer options and hopefully not end up in a poor position (I understand most switch jobs early on, however I’d like to make a solid choice my first go for various personal reasons out of my control). I appreciate any and all feedback you have as I do not have a mentor to guide me through the PP realm.
Job offer through spine surgery group. Would be one of two or three pain docs brought on after previous MD left for geographic reasons...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - January 9, 2024 Category: Universities & Medical Training Authors: hopefulgasman Tags: Pain Medicine Source Type: forums
Medicare advantage trap-
I wish more seniors were aware of this trap and that they can’t go back to regular Medicare.
Older Americans say they feel trapped in Medicare Advantage plans — NPR
As enrollment in Medicare Advantage plans grows, so do concerns about how well the insurance works, including from those who say they have become trapped in the private plans as their health declines.
apple.news (Source: Student Doctor Network)
Source: Student Doctor Network - January 7, 2024 Category: Universities & Medical Training Authors: bedrock Tags: Pain Medicine Source Type: forums
