Feb. 1, 2006

Last Week to Register for FIPP Examination  

Applications are now being accepted for the FIPP examination which will be held on March 12, 2006 in Memphis, TN. Successful completion of FIPP will satisfy requirements for the American Board of Interventional Pain Physicians (ABIPP) Part II examination.

The deadline for applications is Feb. 1. Extensions may be granted upon request up to Feb. 10. For more details on the FIPP exam or to access the application follow this link…FIPP or contact Paula Brashear at (806) 743-3112 or by e-mail: paula.brashear@ttuhsc.edu

Review Course and Cadaver Workshop

Along with the FIPP examination ASIPP is offering the Interventional Techniques Review Course (March 10) and a Comprehensive Interventional Cadaver Workshop (March 11).  ASIPP has secured a group rate of $139 per night with host hotel Springhill Suites Memphis Downtown, if booked by Feb 18th, 2006. Inform the agent you are booking for ASIPP. For information on the review course, cadaver workshop and exam, visit our Web site…March brochure

Update on Louisiana CRNA Issue: Precedence Set

Last December we reported on legal action taken by Spine Diagnostics Center of Baton Rouge, Inc. in response to a ruling by the Louisiana State Board of Nursing that authorized certified registered nurse anesthetists (CRNA) to practice “pain management” procedures. The Nursing Practice Committee recommended that CRNA’s be authorized “to perform pain management procedures including but not limited to peripheral nerve blocks, epidural injections and spinal facet injections.”

The law firm of Keogh, Cox & Wilson, Ltd., on behalf of The Spine diagnostic Center of Baton Rouge, Inc., initiated injunctive relief with the 19th judicial District Court and, filed a Petition for an Advisory Opinion on Nursing Practice with the Nursing Board. 

Letter of intent issued by The law firm of Keogh, Cox & Wilson, Ltd., on behalf of The Spine diagnostic Center of Baton Rouge, Inc.

Louisiana Board Rules Interventional Pain Management May Only Be Performed by Phyisicians

In a January 26, 2006 letter to Keogh, Cox & Wilson, Ltd., the Louisiana State Board of Medical Examiners announced its ruling that interventional pain management procedures “constitutes the practice of medicine and may only be performed in this state by a physician licensed to practice medicine in Louisiana.” This ruling sets precedence for the other states that face similar issues with CRNAs seeking to perform interventional pain procedures.

Read the determination letter from the Louisiana State Board of Medical Examiners…Click here

ASIPP Files Amicus Curiae

This victory was aided in part by the support of ASIPP who filed an Amicus Curiae memorandum on behalf of The Spine Diagnostic Center of Baton Rouge, Inc. ASIPP filed the Amicus Curiae to assist in informing the Court of various facts and issues surrounding the litigation and by defining interventional pain techniques for the Court. See Amicus Curiae

Update on Correct Coding Initiative

CMS has released an update on the Correct Coding Initiative (CCI) in Interventional Pain Management effective Jan. 1, 2006 to March 31, 2006.

New editions are shown in green in the table. The most common additions are: 90760, 90765, 90772, 90774, 90775, C8950, and C8952

Deleted Codes are shown in red. Most common deletions are G0345, G0347, G0351, G0353, G0354

Moved from modifier (not allowed) to Modifier (allowed) are shown in blue. For CPT codes 64470, 64475, and 64483 the following codes 95860, 95861, 95870, 95900, and 95904 are moved from modifier (not allowed) to modifier (allowed).

Click here for CCU updates 2006  and update table

NJ Gov. Signs Bills to Clarify Health Insurance Reimbursement Rules

In his final days of office, outgoing New Jersey Governor Richard Codey signed two bills that set out specific guidelines for health insurance providers to follow in authorizing the delivery and payment of health care services by doctors and hospitals.

Bill S-2824, the “Health Claims Authorization, Processing and Payment Act,” will require that “utilization management” occur according to certain standards when it comes to authorizing certain health care services. The bill would also clarify the rules governing the reimbursement of claims made by health care providers.

The Governor also signed S-1314 which requires that managed care plans furnish doctors covered under their plan with a fee schedule for the 20 most common fees and services under the doctor’s specialty.

AdminaStar Federal Issues Direction on Procedures

AdminaStar Federal, Medicare contractor for Indiana and Kentucky, has issued new direction on transforaminal epidurals. Bilateral is acceptable for first level but not for subsequent levels. Check your state Web sites for more information.

See the supplemental Instructions Article (SIA): Epidural Injections: Transforaminal…Click here

Opioid Guidelines Now Available on ASIPP Web site

You can now access the 2006 “Opioid Guidelines in the Management of Chronic Non-Cancer Pain” which will be published in the Pain Physician journal later this month. The updated guidelines were developed over a six-month period by a large group of pain practitioners representing both academic and private practices. (see list of authors below)

“These guidelines should help pain physicians prescribe opioids safely, effectively, and appropriately,” said lead author, Andrea Trescot. The document, with more than 350 references, reviews the best available evidence as well as the consensus of national experts regarding opioids. Topics covered include the economic impact of chronic pain, the non-medical use of prescription drugs, substance abuse in chronic pain, drug diversion, opioid metabolism, drug interactions, prescription drug monitoring programs, clinical effectiveness, adherence monitoring, and principles of opioid use. To read the opioid guidelines… click here

Pain Physician Journal - The January 2006 issue of Pain Physician Journal (Volume 9, Issue 1) can be accessed on the Pain Physician Journal Web site:   http://www.painphysicianjournal

Current issue highlights:

1. Opioid Guidelines - Andrea M. Trescot, MD, Mark V. Boswell, MD, Sairam L. Atluri, MD, Hans C. Hansen, MD, Timothy R. Deer, MD,Salahadin Abdi, MD, Joseph F. Jasper, MD, Vijay Singh, MD, Arthur E. Jordan, MD, Benjamin W. Johnson, MD,Roger S. Cicala, MD, Elmer E. Dunbar, MD, Standiford Helm II, MD, Kenneth G. Varley, MD, P.K. Suchdev, MD, John R. Swicegood, MD, Aaron K. Calodney, MD, Bentley A. Ogoke, MD, W. Stephen Minore, MD, and Laxmaiah Manchikanti, MD. Opioid Guidelines in the Management of Chronic Non-Cancer Pain.
2. An Invited Review - James Giordano, PhD. Moral Agency in Pain Medicine: Philosophy, Practice and Virtue.
3. Prospective Evaluation - Laxmaiah Manchikanti, MD, Rajeev Manchukonda, BDS, Kim S. Damron, RN, Doris Brandon, CST, Carla D. McManus, RN, BSN, and Kim Cash, RT. Does Adherence Monitoring Reduce Controlled Substance Abuse in Chronic Pain Patients?
4. A Focused Review - Stacy L. Forst, PA-C, Michael T. Wheeler, DO, Joseph D. Fortin, DO, and Joel A. Vilensky, PhD. The Sacroiliac Joint: Anatomy, Physiology and Clinical Significance

ASIPP Members Fight CPT Code 76005-26 Claims Denial

Last September ASIPP members Scott Metzger, M.D. and Peter Saats, M.D. (Metzger Staats Pain Management) began receiving a barrage of Medicare denials on claims coded 76005-26 which were performed outside of their office.  With the assistance of their practice Administrator, Roseann Matias, Metzger and Staats began to fight to get the rulings reversed. For every claim that was denied, Matias sent a request for a reconsideration of the claim and a hearing with a Medicare Hearing Officer.

With this onslaught of paper work, Matias convinced a Medicare Hearing Officer to perform an “ad hoc pull” on their provider number for any place of service outside of their office for code 76005-26. Additionally, the Hearing Officer indicated that she felt their appeals were justifiable and in fact, contended they should not have been denied in the first place. “Unfortunately, until they can fix the systemic problem, we will still have to appeal any claims denied after today’s date,” Matias said.

Matias says they are having similar issues with Aetna but are prepared to fight them as well. While the war is far from over for Metzger and Staats, these victories are encouraging and proof that presenting our cause through calls and letters does work.

ASIPP CEO Laxmaiah Manchikanti, M.D, provided sample letters and also sent a letter to the AMA CPT Committee in support. Read sample letters to Insurer and to AMA CPT Committee… Letters

Ohio Pain Relief Doctor Convicted of Federal Health Care Fraud

A northeast Ohio doctor was convicted on 57 charges of health care fraud and other charges for prescribing painkillers that prosecutors say resulted in the deaths of two patients under his care. Dr. Jorge Martinez, who ran pain relief clinics, is only the second Ohio doctor to be convicted of this offense.

Martinez was found guilty Jan. 12 of submitting $60 million in fraudulent claims to Medicare, Medicaid, the Ohio Bureau of Workers’ Compensation, and private health care plans, and of prescribing unnecessary drugs to patients suffering from chronic pain.

Read more about Dr. Martinez on the Cleveland Scene Web site…clevescene.com

Good News on Malpractice Premiums

A recent issue of Medical Economics addressed the issue of medical malpractice coverage. Saying that according to the latest industry survey, liability rates are “leveling off,” and future increases are likely to be moderate. The article provides a heavy dose of statistics to break down malpractice premium rates across the country. Follow this link to read this informative article. http://www.memag.com

Michigan Doctors - Also in this issue read how Michigan doctors are taking on Blue Cross Blue Shield of Michigan after last year, Michigan Blues transferred about 250,000 autoworkers from traditional indemnity to three new PPOs that are self-insured by General Motors, Ford, and DaimlerChrysler. This move forced many doctors to lower their office visit fees to these patients by as much as 25 percent.  Read more.