New Medicare policy language will make it difficult for anesthesiologists to get reimbursed for facet intervention cases, according to a July 14 blog post by Tony Mira, founder of Anesthesia Business Consultants.
According to one Medicare local coverage determination published earlier this year, facet joint interventions now are considered medically necessary only for patients who fit specific criteria, such as pain being present for a minimum of 3 months with documented failure to respond to noninvasive conservative management. Read more about the qualifications and expectations here.
To avoid these problems, Mr. Mira suggested that practitioners avoid these procedures altogether, although that could create an "unnecessary rift between the anesthesia group and the pain physicians."
Alternatively, providers could provide the service by issuing an Advanced Beneficiary Notice. The ABN would need to outline the likelihood of denial and the estimated cost of the anesthesia service.
Read more here.