Boston Scientific Corporation · NYSE:BSX
Boston Scientific — Investor Presentation (September 2024)
20 slides from Boston Scientific's investor presentation, September 2024
Slide 1: Documentation Best Practices for the Intracept Procedure
Documentation Best Practices for the Intracept™ Procedure
Slide 2: The Why
The Why…… • You already know how to find patients and get them excited about Intracept! But did you know… • Poor documentation results in denials • Denials are frustrating for you and your patients • Approvals increase chances for obtaining and maintaining positive payor policy! 2
Slide 3: Documentation – Life Blood To Authorization
Documentation – Life Blood To Authorization • If it wasn’t documented, it wasn’t done. • Insurers’ decisions about authorization are based upon clinical notes submitted. • Build a base template or dot phrases that includes common medical criteria. • Know the policy specifics – use your checklists to
Slide 4: Positive vs. Negative Intracept Policies
Positive vs. Negative Intracept Policies Positive Policies Have specific requirements for coverage Generate approvals when provider notes include all requirements Generate denials when provider notes lack these requirements Checklists are available in the Resource Center and from the Intrace
Slide 5: Common Coverage Policy Criteria
Common Coverage Policy Criteria Intracept™ Procedure Criteria Detailed Basic Note Dx of Vertebrogenic pain (M54.51) & specific VB to be treated ✓ CLBP 6+ month (be specific) ✓ * exception: 12+ months for some payers Failed 6+ months non-surgical/conservative medical mgmt. ✓ MRI Modic Type I or II (L
Slide 6: Diagnosis of Vertebrogenic Pain
Diagnosis of Vertebrogenic Pain • M54.51 – vertebrogenic low back pain – The most specific code for the Intracept™ Procedure – Issued in 2021 to describe a diagnosis not previously defined • Certain policies limit ICD-10 codes for the Intracept™ Procedure – all policies will include M54.51 6
Slide 7: Failed 6+ months non-surgical/conservative treatment
Failed 6+ months non-surgical/conservative treatment • Be specific about timeframe & results of treatments • Clinic notes should do more than list past treatments • What was tried and failed for low back pain, including but not limited to Physical Therapy, Injection (ESI, MBBs, SI joints), Facet/SI
Slide 8: Modic or descriptors on MRI
Modic or descriptors on MRI Treating provider documents Modic Type 1 or Type 2 changes and which vertebral bodies. MRI report by radiologist corroborates treating provider’s findings. Acceptable documentation. Modic type 1 and/or type 2 at vertebral bodies to be treated *Descriptors include:
Slide 9: VAS Score and ODI
VAS Score and ODI • Many coverage policies require VAS and/or ODI • Clinic note should include: • Visual Analog Scale (VAS) 1-10 score Many require VAS > 4 (used in clinical studies) • Functional capacity score, (e.g. Oswestry Disability Index (ODI)) Many require ODI > 30 (used in clinical studies)
Slide 10: Mental Health Statement
Mental Health Statement A mental health statement is NOT a psychological evaluation! Most payors will allow the treating physician to provide a mental health statement* Attest to the following, are there: Alcohol or substance abuse issues that would preclude the patient from benefiting from
Slide 11: Multi-disciplinary Team
Multi-disciplinary Team • Many payors want a detailed history and physical showing a team of providers have assessed and treated the patient. • Most patients have already seen a multi-disciplinary team – it’s a matter of documenting this in clinic note. • An example statement: • The patient has unde
Slide 12: Documenting non-vertebrogenic pathology
Documenting non-vertebrogenic pathology • Payor policies and LCDs are concerned that there may be another cause for the LBP. • Document the patient’s primary or predominant source of pain is vertebrogenic low back pain based on patient complaints, physical exam and radiology report (presence of Modi
Slide 13: Multi-factorial Pain: Low Back Pain vs. Leg Pain
Multi-factorial Pain: Low Back Pain vs. Leg Pain • Vertebrogenic Pain • Spondylolisthesis • Discogenic Pain • Herniated Nucleus Pulposus • Spondylolysis • Spinal Stenosis • Facet Arthropathy • SI joint Arthropathy 14
Slide 14: Documenting non-vertebrogenic pathology
Documenting non-vertebrogenic pathology Addressing MRI findings • Medical Directors place great emphasis on the MRI report and x-rays • MRIs are sensitive and not specific except when Modic changes are present • Explain radiographic findings that could cause LBP and why they have been ruled-out – no
Slide 15: Coverage & Reimbursement Resource Center
Coverage & Reimbursement Resource Center • Newly created customer reimbursement resource center • One location for all reimbursement tools • Reimbursement Business Manager can send you an access link 16
Slide 16: Coverage Criteria Summary
Coverage Criteria Summary 17
Slide 17: Indications
Indications Indications for Use: The Intracept™ Intraosseous Nerve Ablation System is intended to be used in conjunction with radiofrequency (RF) generators for the ablation of basivertebral nerves of the L3 through S1 vertebrae for the relief of chronic low back pain of at least six months duration
Slide 18: OI STAN
OI STAN
Slide 19: Addendum
Addendum 20
Slide 20: Medicare Local Coverage Determination
Medicare Local Coverage Determination MAC Jurisdiction & States LCD Covered CGS (A Celerian Group Company) J15: KY, OH No First Coast Services Options, Inc. JN: FL, PR US Virgin Island No NGS (National Government Serices) J6: IL, MN, WI No JK: CT, ME, MA, NH, NY, RI, VT Noridian JE: CA, HI, NV Yes J
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