Eyes on the MRIs
How many types of modic are there, and what are they called?
Modic type I, II, III
ASPN assigned BVN as a grade __ evidence rating
A
Name 2 insurance plans that do not need pre-authorization
1 in __ chronic low back pain patients have vertebrogenic pain
6
5.3M patients!
When was Timothy Groth office opened?
2005
True or False: Modic type I is more painful than Modic type II
False
In our clinical studies
2/3 of patients had ____ ____ low back pain
2/3 of patients had ____ pain
midline axial low back pain
flexion pain
This means 1/3 of patients did NOT have midline axial or flexion pain!
Name the policy that requires a mental health statement. Explain how you would document this.
Humana
"Pt A has been evaluated by...."
___ % of low back pain is unresolved at 2 years post diagnosis
74%
Dr. Groth was once the director of which department at Stonybrook University Hospital?
True or False: Endplates with larger area of modic changes and more intense signals are more painful
False, the amount of modic does not correlate to the amount of pain!
Citing the ASPN Guidelines on BVN. On MRI, vertebrogenic pain can be diagnosed by type I or type II modic changes, endplate damage or active schmorls nodes. How can vertebrogenic pain be diagnosed on CT (for patients who cannot get an MRI?)
CT shows increased degenerative endplate changes and SPECT/CT can show increased radiotracer uptake (basically showing inflammation/modic)
Your patient has Aetna Health, what would you tell them in regards to getting the Intracept procedure approved?
Insurance plans without positive coverage policies can take a couple of months or more to get authorization. By signing the consent, we can start the authorization process for Intracept and continue seeing you for treatment in the meantime.
If a patient were to ask you what percent of patients feel better after the Intracept procedure, what would you say?
1/3 of patients are pain free
1/3 of patients have 50-99% relief
1/3 of patients have <50% relief*
*16% of patients have <25% relief
On Dr. Groth's first day in practice, where did he see patients?
In the parking lot
Who discovered modic changes?
Michael Modic in the late 1980s
After 5 years, __% of patients reported resuming the activity level they enjoyed prior to low back pain
69
This insurance policy requires 3 sessions of CBT and a mental health statement
Cigna
There is ___% specificity between modic changes and vertebrogenic pain
93
What # child is Timmy?
#4
Name atleast two other descriptors for vertebrogenic pain besides modic changes on MRI imaging
endplate fissuring, endplate edema, endplate degneration, active schormls nodes
From our pooled 3-year outcomes, ___% fewer patients were actively using opioid medications for low back pain and 84% fewer patients required spinal injections for the same pain source and treatment level at three years following treatment.
74
What is different about the Anthem policy than other payors? How does this change your documentation?
Modic changes verified by 2 independent physicians
Documentation that other causes of low back pain have been excluded (including, but not limited to: chronic lumbar strain, lumbar stenosis, degenerative scoliosis, facet arthroplasty and disc disease)
*In your note address and differentiate other causes of low back pain. Does the patient have radicular pain that is controlled by stim or injections? Did previous spine surgery cause adjacent segment disease and therefore modic changes? Important to paint the patient's story if they are a multifactorial patient.
Histologic studies show higher nerve density 80-90% in endplates compared to discs, which are __-__% innervated
30-40
What was Dr. Groth's first car?
1966 red Belair station wagon