" The Voice Of Interventional Pain Management "

celebrating our 10th anniversary

October 3, 2012


  1. Wall Street Journal Publishes Article on CRNAs in IPM: Nurses Seek Expanded Role
  2. Multi-State Outbreak of Meningitis Following Epidural Injections
  3. CCI 4th Quarter Updates Now Available
  4. New and Revised Content for November ASIPP Meetings: Cut-off Date Extended to Oct. 11
  5. Comprehensive Board Review Videos Available
  6. Join or Renew Your AMA Membership Today!
  7. Many States Not Prepared for Health Care Law 
  8. Medicare Auditor Targets E&M Services for Review

  9. Evan Bayh: ObamaCare's Tax Raid on Medical Devices

  10. Medical Students Lack Knowledge of Health Care Overhaul

NursesWall Street Journal Publishes Article on CRNAs in IPM: Nurses Seek Expanded Role 



Featured in the Wall Street Journal article about the expanded role of nurse anesthetists by Tim Martin, is Jackie Rowles of Indiana, former president of AANA, performing some type of injection in the low back with minimal or no prep with Depo-Medrol under fluoroscopy, and without a mask (which would be in violation of  CDC  guidelines). According to the AANA Web site, Indiana is not an opt-out state for CRNAs to work without the supervision of a physician. It also appears that they are not entitled to use fluoroscopy or interpret radiologic images.


This is a very interesting article which includes comments from Laxmaiah Manchikanti, MD, ASIPP Chairman of the Board. The article provides some of the pros and cons, however, the author misses the GAO request filed to evaluate the qualifications of CRNAs to perform interventional techniques.


Click here to read more.

This is an opportunity for parties to express thier opinions. If you would like to post comments to the article's blog on the Wall Street Journal's Web site, click here  (Please note, this is a Wall Street Journal Professional Sucription article). We encourage members to write letters and post to the article's blog on the WSJ Web site. 


The Saga Continues


Here is addtional informaton on the CRNA saga. Based on ASIPP's request for a GAO study, Congressman Ed Whitfield sent a formal request to the GAO asking them to provide answers to a number of questions:


Do CRNAs have the appropriate education and training to perform chronic pain management services?


What impact would this proposed rule have on access to care for patients seeking chronic pain management?


Whitfield Letter to GAO 


Additionally, 13 doctors from the House of Representatives have signed and sent a letter to the Acting Administrator of CMS, Marilyn Tavenner, on this issue: Congressional Letter to CMS.


While this is encouraging news, we have discovered some very disturbing news regarding this scope of practice issue. ASIPP has learned that the American Association of Nurse Anesthetists (AANA) has taken on a very aggressive and misleading advertising campaign at a national level. On September 21, 2012, they placed a two-page spread feature story advertisement in the national insert USA Today featuring. Distribution markets for the print version of the insert include the New York, Chicago, Los Angeles, and Philadelphia editions of USA Today. According to the AANA Web site, this ad reached a print circulation exceeding 460,000. To view the advertisement, click here: http://doc.mediaplanet.com/all_projects/11025.pdf  


We have done very well so far and ASIPP continues to work on gathering more letters of  support.. Based on our own numbers from ASIPP Web site we have sent nearly 2,000 letters to CMS and over 10,000 letters to members of the congress, this in addition to the numerous phone calls, personal meetings, and the many other letters sent from other organizations, including the American Society of Anesthesiologists, who are collaborating with us on this issue. ISIS also sent a letter to CMS. 


In the coming weeks we have crucial work on this issue to survive into the future. For more information on the CRNA issue please look at the following manuscript:


Proposed physician payment schedule for 2013: guarded prognosis for interventional pain management



UpdateUpdate: Multi-State Outbreak of Meningitis Following Epidural Injections


Additional information is surfacing regarding the outbreak of meningitis following epidural steroid injections. We have learned that the CDC is contacting offices who may have received contaminated product.


Five new cases of meningitis have been confirmed in the past 24 hours in Tennessee, while new cases have been confirmed in North Carolina, Virginia, Maryland and Florida - and the outbreak could potentially spread to even more states. 


Dr. John Dreyzehner, the commissioner of health for the Tennessee Department of Health (TDH) said the total number of cases now stands at 18 - with patients ranging in age from 49 to 89 years old.  Dreyzehner said two people have died since the cases were initially discovered, and several others are listed in serious condition and could die from the rare form of Aspergillus meningitis.


While most of the cases have occurred in Tennessee, North Carolina has identified Monday at least one case that was linked to the meningitis outbreak.  According to the Centers for Disease Control and Prevention, other cases have been reported in Virginia, Maryland and Florida. Both Virginia and Maryland have reported one death each.


The TDH said 737 patients could have potentially been exposed by receiving methylprednisolone, a steroid that is usually injected into the spine to relieve back pain.  Pain management clinics in Nashville, Crossville and Oak Ridge are confirmed to have received the tainted injections dating back to July 30, 2012.  The Oak Ridge clinic confirmed it had received 2,000 injections; however, it is not known how many the Nashville and Crossville clinics received.

The Food and Drug Administration said that they are working with several state health departments and the Massachusetts Board of Pharmacy. They were still investigating the scope and cause of the outbreak. 


Officials said they have identified the compounding center where the drugs were mixed, a facility called the New England Compounding Center. The NECC has conducted a voluntary recall of 3 lots of Methylprednisolone epidural injection that was produced at the facility. 


Please report cases of clinical meningitis, other neurologic infection (i.e. epidural abscess, spinal osteomyelitis, etc.) or cerebrovascular accident with symptom onset within 1 month of epidural injection since July 1, 2012 to Rachel Smith at the Centers for Disease Control and Prevention (CDC) at vih9@cdc.gov / 404-639-7738.

Read more:



NCCICCI 4th Quarter Updates Now Available


The National Correct Coding Initiative (NCCI, or more commonly, CCI) is an automated edit system to control specific Current Procedural Terminology (CPT) code pairs that can be reported on the same day. It was developed by the Centers for Medicare and Medicaid Services (CMS) for use in all Medicare Part B and, more recently, Medicaid claims. The goal of CCI is to eliminate "mutually exclusive" code pairings and codes considered to be components of more comprehensive services or otherwise inappropriate to be delivered to the same patient on the same day. The CCI is updated quarterly.


As a member benefit, we are providing you with the 4th quarter updates for IPM codes.


CCI  Updates for IPM Procedures

revisedNew and Revised Content for November ASIPP meetings: Cut-off Date Extended to Oct. 11


ASIPP is hosting three concurrent sessions November 2-4 in Denver, Co. A comprehensive reivew course and cadaver workshop, a controlled substance mangement course and the coding, comliance and practice management review.


The courses are designed to present interventional pain management

specialists and other health care providers in-depth reviews of multiple areas of

interventional pain management-the areas we were never taught, yet are crucial

for our survival. The course features many nationally recognized experts in pain

management billing and coding and practice management as well as controlled

substance management. In today's environment of regulations and litigations, you

can't afford not to broaden your knowledge and refresh your skills in these areas.



What You Need to Know in Controlled Substance Management.

Educational Objectives


* Review basic science and core concepts

* Discuss pharmacology

* Identify clinical use and effectiveness

* Identify substance abuse

* Discuss topics with documentation, regulatory issues,

legal issues, and ethical issues


Click here for brochure


Click here to register




Essentials in Practice Management in IPM

Educational Objectives :

* Discuss documentation

* Review practice management topics

* Discuss coding and billing

* Examine compliance issues



Click here for brochure


Click here to register




Review Course:


New for this course, we have added:  

  • Anatomy and Physiology, and Psychology of Chronic Pain
  • Bleeding an Infection Control in IPM.

 During the 2½-day Comprehensive Review Course and Cadaver Workshop, you

can improve existing skills and/or learn new techniques. Whether you have been

practicing interventional pain management for many years or are new to the field with

basic skills, we are confident you will find this course and workshop to be beneficial

- as it is essential that we continue learning and exploring new procedures and

techniques in our specialty.


Click here for brochure


Click here to register  


All Three course will be held at Renaissance Denver Hotel, 3801 Quebec Street, Denver, CO 80207 | Tel. 303-399-7500 Click here to book your room under the ASIPP room block (good until COB Oct. 11, 2012).


Cadaver Workshop Location: Science Care, 19301 East 23rd Avenue Aurora, CO


* Special room rates and registration discounts are good through COB October 11, 2012


videosComprehensive Board Review Videos Available

 This Review Course in IPM is designed to prepare physicians seeking board certification, re-certification, or an in-depth review of the specialty of interventional pain medicine.

This review course will be based on the specifications of subspecialty in pain medicine examination of The American Board of Anesthesiology, Physical Medicine and Rehabilitation, and Neurology and Psychiatry. This review course will also meet 90% curriculum of ABIPP Part 1.

This comprehensive Review Course is intended as an overview of the anatomy, physiology, diagnosis, and treatment of a wide range of painful disorders, in order for participants to pass certification or re-certification and obtain in-depth review; and therefore be able to provide improved interventional management, controlled substance management, and practice management.

Order the online videos and receive 5 days of course video via the Internet. You can watch them on your computer or any computer with Internet access. You will be given a password to access the high quality streaming video of each day.
JoinJoin the AMA or Renew Your Membership Today!

The American Medical Association (AMA) requires all societies to requalify for membership in the AMA House of Delegates (HOD) every five years which is 2013 for ASIPP.  In order for ASIPP to retain our seat, the AMA requires that 35% of  our physician members also be members of the AMA . 


We encourage you to join or renew their membership in the AMA. Joining the AMA will further strengthen our specialty's representation at the national level through the AMA House of Delegates, the AMA's policymaking body, and strengthen our ability to meet the challenges in health care today with thoughtful, well-organized responses.


As a member of the AMA, you become part of the organization that unites physicians nationwide to tackle the major issues we all face: 47 million uninsured Americans, looming Medicare payment cuts, the need for medical liability reform. Membership also gives you access to a broad range of practice management resources and award-winning publications such as the Journal of the American Medical Association, AMNews, AMA Morning Rounds and the Archives journals.


Please take this opportunity to support the critical activities of ASIPP by joining the AMA today. To join or renew the AMA, we encourage you to visit www.ama-assn.org or call (800) 262-3211.


ManyMany States Not Prepared for Health Care Law


More than three dozen states could be unprepared or unwilling to set up the insurance marketplaces called for under the 2010 health-care law, leaving at least part of the task up to the federal government, according to a new report.Thirteen states and the District of Columbia have formally expressed their intention to set up the marketplaces, which are known under the law as health insurance exchanges. But many of the rest of the states are behind in their planning or have decided not to operate exchanges on their own, according to a report from the Health Research Institute, the research arm of PricewaterhouseCoopers's health-care consulting business. Even some of the 13 that plan to set up the exchanges might not be ready for enrollment by October 2013, the report said. If a state does not set up an exchange, the federal government will either partner with the state or be the sole operator in that state.

The Washington Post 

MedicareMedicare Auditor Targets E&M Services for Review


A Medicare auditor tasked with reviewing past claims for physician and hospital services in 15 states will start scrutinizing the billing of office visits, claims that previously had been off-limits to recovery audit contractors.


The RAC revealed its plans to conduct limited reviews in southeast and mid-Atlantic states using a statistical sampling to project how many physician claims that used the high-level, established patient evaluation and management code 99215 were paid incorrectly. The contractor, Atlanta-based Connolly Inc., will scour claims filed by doctors and hospitals with dates of service as far back as Oct. 1, 2007.


AMA News  

EvanEvan Bayh: ObamaCare's Tax Raid on Medical Devices


The Supreme Court decision in June upholding the Affordable Care Act leaves in place a tax on medical devices that threatens thousands of American jobs and our global competitiveness. It will also stifle critical medical innovation in the industry that gave us defibrillators, pacemakers, artificial joints, stents, chemotherapy delivery systems and almost every device we depend on to save lives.


The 2.3% tax will be charged to manufacturers on each sale and takes effect in January. Many U.S. device companies, in response, have already announced layoffs, canceled plans for domestic expansion and slashed research-and-development budgets. This month, Welch Allyn-a maker of stethoscopes and blood-pressure cuffs-announced that it will lay off 10% of its global workforce over the next three years, but all of the jobs being cut are in the U.S.

The Wall Street Journal 

MedicalMedical Students Lack Knowledge of Health Care Overhaul


The 2010 Affordable Care Act affects almost every aspect of the U.S. healthcare system, but many future doctors who will be operating under its policies admit they don't know that much about the law.


In a survey of about 850 medical students in Minnesota, less than half said they understood the healthcare law's basic components, and more than 40 percent said they had no opinion on the law.


Reuters Health 




All contents Copyright © 2008
American Society of Interventional Pain Physicians ®
81 Lakeview Drive, Paducah, KY 42001
Phone 270.554.9412, Fax 270.554.5394
E-mail asipp@asipp.org