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Medical Treatment Guidelines
#1
NYS- I’ve looked through the Medical Treatment Guidelines a couple times but not sure if I’m looking in the right place. Has anyone seen or know if it’s in the guidelines where the leads are placed for a permanent spinal cord stimulator ? So if it’s lumbar spine injury does it say anywhere in the guidelines that the leads are placed in the thoracic region ? Thank you
 
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#2
I know when I had mine placed, the surgeon went through the middle of my back and had them go down towards my lumbar. My Insurance Carrier didn't question this at all.
 
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#3
(12-30-2018, 01:45 PM)redsoxfan Wrote: NYS- I’ve looked through the Medical Treatment Guidelines a couple times but not sure if I’m looking in the right place. Has anyone seen or know if it’s in the guidelines where the leads are placed for a permanent spinal cord stimulator ? So if it’s lumbar spine injury does it say anywhere in the guidelines that the leads are placed in the thoracic region ? Thank you

From what I have read the leads can be placed where the pain is. I am not sure if this helps you. I don't know if your state has specific medical treatments guidelines for work comp. Here is an example of a medical treatment guideline. It lists different ICD codes. I would definitely as if your doctor is going to do a laminectomy as it is listed and some have not been told about it in advance. In my state we use MTUS chronic pain guidelines and it is very basic and makes no mention of where the leads are to be placed.

https://medicalpolicies.amerigroup.com/m...056827.htm


If you have the medical device name and product code it may be a good idea to look it up and read where the leads can be placed. (JMO)
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#4
If you received a denial letter for this procedure citing leads placement, did the denial cite the guideline? Maybe I am not understanding your question but in my state they cite the guideline usually with the written denial or where they got it from.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#5
I had the Nevro SCS installed in May and the neurosurgeon placed the paddles in the thoracic region. The surgeon told me he would wait to see during the surgery whether he would use leads or the paddles. He ended up using the paddles and had to do a laminectamy for the placement. The carrier refused to pay any bills because the thoracic region wasn’t an established body site. I went to court and the judge ruled in my favor but the carrier appealed the decision. After the appeal process the judges ruled in my favor but the carrier asked for a reconsideration from a full panel review. They state there was no mention of the thoracic area from any of my doctors regarding the permanent placement yet both SCS trials the doctor explains exactly where the leads were placed and the carrier paid both bills. My injury was to the lumbar spine and pain radiating down my leg. I had numerous injections after I had failed back surgery so the SCS was definitely warranted. It’s just an argument over the wording of my doctors and the comp judges. That’s why I was wondering if it was stated in the medical guidelines where the the placement of the paddles should be for lumbar injuries. My lawyer did say that the full panel review hardly ever overturns their decision from an appeal but I guess I’ll see
 
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#6
I did a search on the Nevro SCS and they have what it looks like a free CTP code/utilization appeal/reimbursement department. It has a phone number if you want to call them and discuss this issue. I am curious if they will help you.

https://www.nevro.com/English/Reimbursem...fault.aspx
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#7
Thank you I will call them this week. Have a happy ne year!!!
 
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