1 Future Medical Cost ProjectionsModule 4 Common Treatments, Part 2

2 Common Treatment ModalitiesOverview Discusses common treatment modalities for pain pumps, medications, surgeries Objectives Be able to list at least 5 categories of medications Be able to name the 3 major categories of orthopedic surgery Be able to determine types of laboratory most often required Copyright InSitu Academy

3 Copyright InSitu AcademyCommon Treatments Medical Injections Spinal cord stimulator Pain Pump Medications Laboratory Diagnostics Surgery Therapy Equipment Physician Home Care Copyright InSitu Academy

4 Copyright InSitu AcademyPain Pump not as commonly encountered since SCS used more frequently Multiple medications typically prescribed Combination of medications used for both nociceptive and neuropathic pain Costs associated with pain pump Installation Replacement units Monthly refills Office visits Very/very expensive Copyright InSitu Academy

5 Copyright InSitu AcademyMedications Significant lifetime cost exposure Clients provide current list of medications Spell name, read off bottles Verify, if able, through medical records Retail pricing: goodrx.com/CVS pharmacy Use generic if available Compounded drugs Try contacting dispensing pharmacy or supplier Reluctant to provide information Allowance of $300 per month if unable to obtain pricing Actual cost can be as high as $1800 per month Copyright InSitu Academy

6 Copyright InSitu AcademyCommon concerns Off label use Patent expiration Pre-existing conditions: prior medications Copyright InSitu Academy

7 Copyright InSitu AcademyTypical categories Anti-inflammatories (NSAIDS) Analgesics Narcotics Muscle relaxers Sleep aids Psychotropic ED Topical Inhaled Copyright InSitu Academy

8 Copyright InSitu AcademyLaboratory CBC, CMP, venipuncture (liver and kidney function) 1-5 prescriptions: 1 draw per year 5+ prescriptions: 2 draws per year Endocrine testing as needed Therapeutic levels of certain medications Klonopin Coumadin, heparin Anti-seizure meds Urine drug screening: 4 per year allowance Blood studies are monitored by family practice, include visits corresponding with draws Urine testing is monitored by pain management physician Copyright InSitu Academy

9 Copyright InSitu AcademyDiagnostics MRI, CT, xrays Frequency Factors Severity of injury Prior surgery Degenerative condition Multiple sites of injury Projection Every 5 years for conservative cases Annually for more complex cases Lifetime allowance Copyright InSitu Academy

10 Professional ComponentEvery diagnostic procedure has a professional component for interpretation CPT modifier -26 denotes professional component Include both the CPT code for the diagnostic procedure and the CPT code/-26 for the interpretation Example: Xray of knee, 4 views CPT $39.00 Professional component CPT $17.00 Total cost $56.00 Copyright InSitu Academy

11 Copyright InSitu AcademySurgery Arthroscopy: used to visualize, diagnose, or treat, most often joints of the shoulder, hip, knee, ankle, wrist Arthroplasty: reconstruction or replacement of a joint, most often joints of the shoulder, hip, knee, ankle Arthrodesis: immobilization of joint by fusing adjacent bones, most often the spine or ankle Copyright InSitu Academy

12 Copyright InSitu AcademyShoulder Shoulder Ball and socket joint 3 parts of the replacement: lining, ball, pin Partial or full replacement or revision Lasts approximately years Also reverse shoulder replacement which limit range of motion Copyright InSitu Academy

13 Copyright InSitu AcademyHip Hip Shallow ball and socket joint 3 parts: lining, ball, pin Dislocation a common complication Lasts about years Copyright InSitu Academy

14 Copyright InSitu AcademyKnee Knee Hinge type joint Extensive physical therapy following replacement Lasts years dependent on level of activity Copyright InSitu Academy

15 Copyright InSitu AcademyAnkle Ankle Limits motion and function Contributes to gait derangement Leads to back pain Not commonly performed Copyright InSitu Academy

16 Copyright InSitu AcademySpine Surgery Laminectomy, Laminotomy Relieves radicular pain Excision of disc material only Most often followed with fusion type surgery Fusion Copyright InSitu Academy

17 Copyright InSitu AcademyLaminectomy-otomy Lumbar stenosis Open decompression Provides unrestricted neural pathway Reduces pain, leg weakness, neurological symptoms --otomy: incision into lamina --ectomy: removal of lamina Copyright InSitu Academy

18 Copyright InSitu AcademyFusion Arthrodesis Installation of hardware to stabilize adjacent vertebrae Considerations in cost projections Hardware in/hardware out Future fusion at adjacent levels Implanted hardware, caution for MRI Approaches Posterior: lumbar spine Anterior: cervical spine Swallowing difficulty, hoarseness Copyright InSitu Academy

19 Copyright InSitu AcademyHomework Compile a list of replacement scheduling for all major joint replacements, create cheat sheet Create cheat sheet for CBC, CMP, venipuncture CPT coding and mid-range cost using usual/customary fee schedule Copyright InSitu Academy

20 Copyright InSitu AcademyContact Information Copyright InSitu Academy