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.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.