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Update October 14, 2022: A letter has been sent today to the Medical Directors of multiple MACs regarding Proposed LCD-Sacroiliac Joint Injections and Procedures. Click here to read the letter

On March 10, 2022, a multidisciplinary evidentiary CAC meeting was held with the collaboration of multiple MACs. To date, NGS, Noridian, WPS, and Palmetto have posted their proposed LCDs. CGS has announced an open CAC meeting, but we are awaiting for their LCD to be posted. First Coast and Novitas did not participate in the evidence development. Consequently, we are not sure if they will be posting a proposed LCD or not.

There are various dates for comment periods, with Palmetto having the first comment period closing date of Oct. 15, 2022. Please look over the LCD.

The policy does not show any major requirement changes, but it does tighten all the requirements, like facet joint injections. However, there is one problematic change related to sacroiliac joint radiofrequency neurotomy. In this proposed policy, this is considered as investigational and not covered.

ASIPP will be sending the comment letter within the comment period. If you would like to comment, please make sure that you comment prior to the deadline.

Again, the comment period on the proposed LCD for Sacroiliac Joint Injections and Procedures (DL39402) through Palmetto ends on October 15, 2022. Other Medicare Contractors’ comment closing dates are soon after.

Please see the table on the ASIPP website with the Medicare Contractors, comment period and public meeting dates, links, etc.

Here is the link to submit comments to Palmetto and view the LCD. Click here.

We will continue to update you on the future comment dates and public meetings.
Important News! 
 
United Healthcare’s new policy reverses the previous policy with a limit of three (3) epidural injections to the ASIPP recommendation of four (4) procedures per year.  
 
As you know, ASIPP has resolutely advocated for a change in the policy on epidural injection limits of three (3) per year through evidence-based presentations and communication. We first sent a letter on June 21, and they responded on June 27. Since then, we have continued with multiple other correspondences. Consequently, they published the new policy effective November 1, 2022, which now provides coverage for four (4) procedures.
 
Coverage rationale and documentation requirements have also changed somewhat more favorably for physicians. See United Healthcare Policy
 
As a reminder, after much effort and many correspondences on the part of ASIPP, percutaneous adhesiolysis is now covered in all states, following the reversal of noncoverage policies of Noridian and Palmetto. 
 
We are still awaiting the response from Centene in reference to the continuation of the epidural injections when indicated beyond one year. We will keep you posted on the developments. See Letter to Centene. 

Need to catch up on earning your
CME Credits before 2022 is over?

Here is an excellent opportunity offered by ASIPP to earn
19.5 AMA PRA Category 1 CreditsTM in Chicago, November 11-13
Palmer House Hilton by Thursday, Oct. 20th for a discounted rate!




Great news! Representatives Larry Bucshon (R-Ind.) and Ami Bera (D-Calif.), are introducing a bill that would prevent a 4.4 percent Medicare physician fee payment cut from taking effect on January 1, 2023, through the introduction of the Medicare Access and CHIP Reauthorization Act of 2015 and associated payment mechanism.

This is the bill we have been requesting from members of the Congress to introduce for some time for the last few months. ASIPP has supported this and ASIPP members have sent over 5,000 letters to Members of the Congress to date.

Representatives Bucshon and Bera are supported in this endeavor by six additional representatives, Kim Schrier M.D. (WA-08), Michael Burgess, M.D. (TX-26), Earl Blumenauer (OR-03), Brad Wenstrup, D.P.M. (OH-02), Bradley Schneider (IL-10), and Mariannette Miller-Meeks, M.D. (IA-02). Together they sent a Request for Information: Medicare Payment System Reform letter to members of Congress. See RFI Letter







UnitedHealth Group’s profits eclipsed $5.2 billion in the third quarter on a strong performance by its Optum health services and UnitedHealthcare health plans.

UnitedHealth, which continues to see success as both a provider of medical care benefits under the Optum umbrella and as a company that pays for benefits through its health insurance plans, Friday said third quarter net income increased to $5.26 billion compared to $4.28 billion in the third quarter of 2022.

The growth was diversified across all platforms with total revenues rising 12% to $80.9 billion in the quarter compared to $72.3 billion in the year ago period.

Friday’s earnings report signaled a stronger performance for the rest of the year with UnitedHealth chief executive Andrew Witty telling analysts on the company’s earnings call that UnitedHealth’s performance allows “us to deliver durable and balanced growth and to increase our 2022 adjusted earnings outlook to a range of $21.85 to $22.05 per share.”

REMAINING PART I EXAM DATES THIS YEAR:
  • October 22
  • November 19
  • December 17








The United States on Thursday extended the COVID-19 pandemic's status as a public health emergency for another 90 days, thereby preserving measures like high payments to hospitals and expanded Medicaid.

The extension was announced by U.S. Health Secretary Xavier Becerra on Thursday. Last month, President Joe Biden said in an interview that "the pandemic is over," which prompted criticism from health experts.

The toll of the COVID-19 pandemic has diminished significantly since early in Biden's term when more than 3,000 Americans per day were dying, as enhanced care, medications and vaccinations have become more widely available.


Something about Covid causes a significant portion of people to experience symptoms long after the initial sickness – so what do the studies tell us?

Earlier this year, CDC researchers pored through millions of American health records looking for patients who might have long Covid. But figuring out who has the condition isn’t easy.

That’s because there is no test for long Covid.

In fact, scientists still don’t know what exactly causes it.

Long Covid is a catchall term to describe an array of symptoms people experience weeks or months after they recover from Covid-19, usually when they are no longer infectious. Some people have reported experiencing several of them; others report just one or two.






By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.

The health system Kaiser Permanente called doctors in during lunch and after work and urged them to add additional illnesses to the medical records of patients they hadn’t seen in weeks. Doctors who found enough new diagnoses could earn bottles of Champagne, or a bonus in their paycheck.

Anthem, a large insurer now called Elevance Health, paid more to doctors who said their patients were sicker. And executives at UnitedHealth Group, the country’s largest insurer, told their workers to mine old medical records for more illnesses — and when they couldn’t find enough, sent them back to try again.

Please plan to join us at the
2023 ASIPP Annual Meeting
March 16-18 National Harbor, Maryland

Register Early
More details will be posted on our website at asipp.org.
Registration begins November 2022.
For meeting or exhibitor/sponsor information:
Email Karen Avery at kavery@asipp.org or call 270.554.9412 ext 4210
- ASIPP Members Only Site Information -
  1. To log in for the first time you will need to click “forgot password” at the bottom of the login window.
  2. Check your email and then log in as directed.
  3. If you have problems logging into your account, click here.
Pain Medicine Case Reports (PMCR) and Editor-in-Chief Alaa Abd-Elsayed, MD, PhD would like to invite you to submit case reports and case series to the PMCR journal. Your article will be published free of charge.

Open access journals are freely available online for immediate worldwide open access to the full text of published articles. There is no subscription fee for open access journals. Open access journals are no different from traditional subscription-based journals: they undergo the same peer-review and quality control as any other scholarly journal.

Interested in becoming a member of the PMCR Editorial Board?
Editorial board members are asked to review 2-6 manuscripts per year. Please submit your most up-to-date CV to sgold@asipp.org for consideration.

For more information or to submit your articles, click here.
| CASE REPORT |


Nirguna Thalla, MD, Eduardo J. Carrera , Ryan Russell, BS, and Mehul J. Desai, MD


Abstract
BACKGROUND: Globus sensation is a nonpainful sensation of a lump or foreign object stuck in the throat that is not associated with dysphagia. Persistent globus sensation is distressing for patients and often the result of no clear etiology.

CASE REPORT: We present a case of a 71-year-old woman with persistent globus sensation following cervical spine surgery. Initial evaluations for etiology and treatment included hardware removal, endoscopy, pharmacological treatment, botulinum toxin injections, collagen injection laryngoplasty, speech therapy, anesthetic nerve blocks, and attempts at peripheral nerve stimulation. These interventions were not successful in relieving her sensation. After 60 days of peripheral nerve stimulation to her bilateral recurrent laryngeal nerves, she experienced a dramatic 90% reduction in her symptoms with subsequent improvement in quality of life.

CONCLUSION: Peripheral neuromodulation is a potential treatment option for refractory globus sensation.

KEY WORDS: Case report, globus sensation, neuromodulation, peripheral nerve stimulation, recurrent laryngeal nerves

| RANDOMIZED TRIAL |


Alshaimaa Abdel Fattah Kamel, MD, Khadeja M. Elhossieny, MD, Ahmed S. Hegab, MD, and Dina Abdelhameed Elsadek Salem, MD


Abstract
Background: Anesthesiologists are always looking for a regional analgesic technique which is easy, safe, has a low complication rate, and provides satisfactory analgesia. A retrolaminar block is a recent modified paravertebral technique for analgesia in thoracoabdominal procedures with a local anesthetic injected at the retrolaminar site. It has the advantage of being safe and easy compared with traditional thoracic epidural analgesia but is still under investigation.

Objective: This study aimed to compare ultrasound-guided bilateral retrolaminar block with ultrasound-guided thoracic epidural analgesia for pain relief after laparoscopic cholecystectomy.

Study design: A prospective randomized double-blinded clinical study.

Setting: Academic University Hospitals.

Methods: Fifty-two adult patients were randomly allocated into 2 equal groups at the end of the surgery: Group R (n = 26) received a bilateral ultrasound-guided retrolaminar block with 20 mL of 0.25% bupivacaine and 5 µg/mL adrenaline (1:200000) in each side. Group T (n = 26) received ultrasound-guided thoracic epidural analgesia with 20 mL of 0.25% bupivacaine and 5 µg/mL adrenaline (1:200000).

Results: The Numeric Rating Scale scores both at rest and during cough were statistically significantly lower in Group R compared with Group T at 30 minutes and one hour postoperatively. The pain scores were statistically significantly lower for about 4 hours in Group R group compared with 6 hours in Group T. The time for the first call of nalbuphine was highly statistically significantly shorter in Group R group (233.04 ± 5.27 minutes) compared with Group T (353.77 ± 5.16 minutes) (mean difference -120.37, (95% CI, -123.6 to -117.8) P < 0.001. The total amount of nalbuphine consumption in the first 12 hours was statistically significantly decreased in Group T (17.31 ± 5.52 mg) compared with Group R (27.69 ± 5.52 mg) (Mean difference 10.4, 95% CI 7.3-13.5), P < 0.001. The total number of patients who developed nausea and vomiting were statistically significantly greater in Group T (9 patients) compared with Group R group (3 patients), P = 0.04. Moreover, hypotension was statistically significantly more common among patients in Group T group (10 patients) compared with Group R (3 patients), P = 0.025. Both groups were comparable regarding patient satisfaction.

Limitations: There is limited literature in the field of the present study and sensory dermatome assessment, but this does not affect the results as we used an ultrasound-guided technique.

Conclusions: A single injection retrolaminar block provides adequate postoperative pain relief for about 4 hours compared with a single shot thoracic epidural that lasts about 6 hours. Patient satisfaction with both techniques was the same; about two-thirds of the patients were satisfied or very satisfied with either block.

Keywords: laparoscopic cholecystectomy; pain relief; thoracic epidural; Retrolaminar block.

| CROSS-SECTIONAL STUDY |


Kyeong Hwan Seo, MD, Francis Sahngun Nahm, MD, PhD, Woong Ki Han, MD, Ho Young Gil, MD, Jung Eun Kim, MD, PhD, Eun Joo Choi, MD, and Pyung Bok Lee, MD


Abstract
Background: Deciding whether to continue or discontinue aspirin prior to interventional procedures is a major concern for pain physicians. Many guidelines have been published on the discontinuation of aspirin before invasive procedures; however, the recommendations are inconsistent and do not consider individual platelet function. Furthermore, many studies have shown a high prevalence of aspirin resistance in patients taking this medication.

Objectives: To determine the necessity of discontinuing aspirin prior to interventional pain procedures in relation to individual platelet function.

Study design: Multicenter, cross-sectional study.

Setting: University-affiliated hospitals.

Methods: We examined platelet function among patients scheduled for an interventional pain procedure by measuring their closure time using collagen/epinephrine cartridges in a commercial platelet-function analyzer. The patients were categorized into either an aspirin-taking or nonaspirin-taking group (Group A or Group N, respectively). The proportion of patients who showed normal/abnormal platelet function was calculated and compared between the groups.

Results: A total of 1,111 patients were included in this study. In Group A, 56.4% (102/181) showed normal platelet function, whereas 43.6% (79/181) showed abnormal platelet function. In Group N, 85.8% (798/930) and 14.2% (132/930) showed normal and abnormal platelet function, respectively.

Limitation: The proportion of laboratory, not clinical aspirin resistance was evaluated. Factors affecting platelet function were not investigated exhaustively.

Conclusion: The high prevalence of normal platelet function in patients taking aspirin suggests no necessity of discontinuation before procedures in such patients. Abnormal platelet function can occur even in patients who are not taking aspirin. Therefore, platelet function should be measured and considered on a case-by-case basis prior to interventional procedures, and discontinuation of aspirin should be decided based on these factors.

Keywords: collagen; epinephrine; guideline; nerve block; pain; platelet aggregation; platelet-function tests; Aspirin.



ASIPP is now in collaboration with Curi Medical Liability Program


Since this malpractice insurance program officially launched in November 2018, ASIPP has signed up hundreds of providers with an average savings of 30%. This is professional liability insurance tailored to our specialty and will stand up for us and defend our practices.
 
Curi is a full-service advisory firm that serves physicians and their practices. Their valued advice is grounded in your priorities and elevated in your outcomes. They are driven by a deep understanding of your specific circumstances in medicine, business, and life. To read a few important points to keep in mind about the program, including discounts, administrative defense, cyber coverage, aggressive claims handling, and complimentary risk management CME activities, visit our website.

ASIPP® has formed a partnership with Henry Schein and PedsPal, a national GPO that has a successful history of negotiating better prices on medical supplies and creating value-added services for independent physicians. Working with MedAssets, PedsPal provides excellent pricing on products like contrast media that alleviate some of the financial pressures you experience today.

ASIPP® is now offering our members the benefit of a unique revenue cycle management/ billing service.

We have received a tremendous amount of interest in the ASIPP® billing and coding program.

Click here to learn more about the negotiated rate for practices and more!
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