American Society of Interventional Pain Physicians | November 7, 2018
CMS releases final 2019 fee schedules for physicians, HOPDs, and ASCs:  
Mixed news for interventional pain management physicians
The Centers for Medicare and Medicaid Services (CMS) released the final 2019 Medicare physician fee schedule (PFS), ASC & HOPD rules, addressing Medicare payment rates and policy provisions for 2019.
The rule is a mix of achievements and some failings for interventional pain physicians:
1.  Physicians will see a 0.1% conversion factor payment increase on January 1, 2019. The issues impacting interventional pain physicians with EM documentation guidelines and IPM payment rates are as follows:
  • Physicians will no longer be required to re-record elements of history and physical exam when there is evidence that the information has been reviewed and updated. In addition,
  • Physicians must only document that they reviewed and verified information regarding chief complaint and history that is already recorded by ancillary staff or the patient.
However, these changes apply only for Medicare patients. As of now, we do not know if Medicaid and all other payers will follow these rules or guidance.
2.  CMS is not moving forward on a proposal to reduce payment for office visits when performed on the same day as another service.
3.  CMS is also not moving forward for 2019 and instead postponing to 2021 the proposed single payment rate for Level 2 through Level 5 office visits and to reduce documentation requirement for this collapsed payment of that of a Level 2 CPT visit code.
4.  IPM procedural payment changes proposed are retained in the final rule with minor additional increases of 1% to 3% for some procedures. The proposed rule itself had a significant increase for CPT 63650 (from $1,353.72 to $1,613.43) for percutaneous lead placement in an office setting which actually has been increased further to $1,657.08. The IPM payment schedule is as follows:     
However, CMS has not increased the reimbursement peripheral nerve blocks and neurolytic blocks. There are also reductions for interspinous prosthesis.
ASC & HOPD Payment Rates:
Good News:
We are seeing increases of:
  • 12.5% from 2018 for Percutaneous adhesiolysis procedure, transforaminal epidural injections, facet joint injections, sympathetic blocks, celiac plexus, intercostal nerve and pudendal nerve neurolysis from $350.20 to $393.80.
  • 8.9% from 2018 for Cervical and lumbar interlaminar epidural injections and Sacroiliac joint injections from $283.10 to $308.32.
Proposed payment rates are retained in the final rule with minor decreases of 1% to 2% for some procedures
CMS did not consider our request to increase the reimbursement for peripheral nerve blocks and neurolytic blocks, epidural injections (CPT codes
62321 and 62323) and percutaneous adhesiolysis (CPT 62264).

Abstract Submission Open!

Abstract submissions are now being accepted for the 2019 ASIPP Annual Meeting Abstract and Poster Contest. The top 10 abstracts selected by our panel will be presented at the annual meeting. The top 25 abstracts will be presented as electronic posters in view for all our attendees.

Click HERE to submit. Deadline is Feb. 18

February 22-24, 2019
Orlando, FL
FDA approves opioid painkiller 1,000 times stronger than morphine

A new opioid tablet that is 1,000 times more potent than morphine and 10 times stronger than fentanyl was approved by the Food and Drug Administration Friday as a fast-acting alternative to IV painkillers used in hospitals. 
The painkiller Dsuvia will be restricted to limited use only in health care settings, such as hospitals, surgery centers and emergency rooms, but critics worry the opioid will fuel an already grim opioid epidemic. 
Democratic Senator Ed Markey of Massachusetts urged the FDA not to approve the painkiller last month,  saying  “an opioid that is a thousand times more powerful than morphine is a thousand times more likely to be abused, and a thousand times more likely to kill."

ASIPP HIPAA WEBINAR – Registration Open!
Date: November 14, 2018
Time: 11am-12:30pm CDT
Cost: $150
Length: 60 minute presentation and 30 minute Q&A
CEUs: 1.5 hrs
Presenter: Vicki Myckowiak, esq

The federal government is focusing more attention on the privacy and security of patient health information. Failure to meet the requirements for HIPAA can lead to thousands of dollars in fines and unwanted media attention. Are you HIPAA compliant? What about your business associates? Have you done the required HIPAA Risk Assessment? How will you respond if there is a government investigation?
Vicki Myckowiak, an expert in HIPAA in interventional pain practices, will provide a practical and understandable presentation to help move you through the sometimes overwhelming HIPAA requirements so that you can feel comfortable that you are meeting the government requirements.
This webinar will include information on: HIPAA Security for your practice, doing the required risk analysis and how to avoid patient electronic records from being stolen including:
•   What is HIPAA and Who Oversees it
•   Who must comply
•   What information needs to be protected
•   What are business associate agreements and who needs them.
•   How to do a required HIPAA Risk Analysis
•   What happens if you don't comply and how much can you pay
•   Where to get started

'I Had Not Kept Up': A Physician Re-Education Story
Patient's overdose made Jeoffry Gordon, MD, recognize he didn't know everything

Decades ago, California Gov. Jerry Brown twice named San Diego physician Jeoffry Gordon, MD, to sit on the board that licenses -- and disciplines -- the state's physicians. During those 8 years, his "DocSwat" agency aggressively went after narcotic overprescribers. It even manually searched pharmacy triplicates to proactively identify the worst offenders.
Gordon, 76, retired from his solo beach-area practice 4 years ago. He went to work part-time for a large federally qualified health center and its population of complex, low-income, and very difficult patients, many of whom had a history of substance abuse.

With 5 decades of experience, Gordon prided himself on being able to treat his patients with heart disease or diabetes -- as well as chronic pain -- all by himself, without referring them out. He'd taken the state-mandated course on managing pain and kept up with his CME.
But this summer, Gordon was criticized by his medical director and peer reviewers for his prescribing practices. As careful as he thought he was, one of his pain patients was hospitalized with a heroin overdose.

Intensive Patient Education Flops for Acute Low Back Pain

Adding 2 hours of intensive patient education to first-line care in acute low back pain patients was no better at reducing pain intensity than placebo, a  randomized clinical trial  in Australia found.
While intensive education sessions were tied to slightly lower levels of disability, they were no more effective than placebo in improving pain at 3 months, reported Adrian Traeger, PhD, of the University of Sydney, and colleagues in  JAMA Neurology .

Interventional Pain Management Reports is an Open Access online journal, a peer-reviews journal dedicated to the publication of case reports, brief commentaries and reviews and letters to the editor. It is a peer-reviewed journal written by and directed to an audience of interventional pain physicians, clinicians and basic scientists with an interest in interventional pain management and pain medicine. 

Interventional Pain Management Reports is an official publication of the American Society of Interventional Pain Physicians (ASIPP) and is a sister publication of Pain Physician . Interventional Pain Management Reports Interventional Pain Management Reports is an open access journal, available online with free full manuscripts.  

The benefits of publishing in an open access journal that has a corresponding
print edition journal are:  
  • Your article will have the potential to obtain more citations.
  • Your article will be peer-reviewed and published faster than other journals.
  • Your article can be read by a potentially much larger audience compared with traditional subscription-only journals.  
  • Open Access journals are FREE to view, download and to print.

So submit today your:
  • Case Reports
  • Technical Reports
  • Editorials
  • Short Perspectives

The Unintended Consequences of the CDC Opioid Guideline According to Pain Management Specialists

The guideline formulated by the Centers for Disease Control and Prevention (CDC) in an effort to curb opioid overdose-related deaths included a recommendation for steep reductions in opioid doses for patients taking high doses of the drug for chronic pain — including individuals with no evidence of drug addiction or misuse. 1  This guideline has had dire consequences for patients and the physicians who treat them, according to critics. 2
The guideline formulated 12 overarching recommendations, including a preference for the use of nonopioid vs opioid treatments and for the use of immediate- vs extended-release or  long-acting opioids  when initiating therapy. The guideline also urged   clinicians to weigh the benefits and harms of opioid therapy soon after initiation of therapy and frequently thereafter and to use precaution when considering escalating doses to ≥90 morphine milligram equivalents/day. Four recommendations were based on low-level evidence and 7 on very low-level evidence. Additionally, in its review of clinical evidence, the guidelines committee chose to include only trials on the effectiveness of long-term opioid therapy with observation periods more than a year, despite that the majority of trials examining this issue had active treatment durations totaling 12 weeks or less. 1-3

November Podcast Now Available

Miles Day of Texas Tech Discusses Multiple Pain Management Techniques
Miles Day, MD, DABA, FIPP, DABIPP, Treweek/ Racz Endowed Professor in Pain Research, Pain Management Fellowship Program Director, Department of Anesthesiology, Texas Tech University Health Sciences Center discusses pain management with Hans Hansen, Interventional Pain physician and the ASIPP Podcast producer. Dr. Day is internationally known throughout the pain community by face and name. He is the Program Director of the Pain Management Fellowship Program at one of the leading institutes for training and developing pain management as we know it. Dr. Day takes us through an interesting discussion about what it takes to be competent to sit for the Board Exam. Only 300 passed the test last year and can enter the world of pain management and be able to help those that suffer the most with painful conditions. It's an evolving field and keeping residents abreast of safe and effective techniques is daunting. Dr. Day also discusses where the pain management field is headed. Join us on this journey with Dr. Day and his perspective from one of the premiere pain management institutes in the world.

Click HERE to listen!
State Society News 
November 8-11, 2018
NY/NJSIPP Pain Medicine Symposium 2018 
Hyatt Regency Jersey City.
CLICK HERE for more details

November 12 and 14, 2018
FSIPP Regional Meetings: 
November 12, 2 018 @6:30pm
Carrabba's Italian Grill
2370 SW College Road, Ocala, FL 34471
November 14, 2018 @6:30pm
Carrabba's Italian Grill
5820 Red Bug Lake Road, Winter Springs, FL 32708
CLICK HERE to register for either meeting

July 12-14, 2019
GSIPP 2019 - 15th Annual Meeting & Pain Summit
The Cloister Hotel at Sea Island
Sea Island, GA
For more information, contact Karrie Kirwan at or Tara Morrison at or 770-613-0932.

July 26-28, 2019
PAIN 2019
West Virginia Society of Pain Physicians
Loews Miami Beach, FL

Send in your state society meeting news to Holly Long,
ASIPP | Pain Physician Journal | Phone | Fax | Email