Cryoneurolysis Pearls & Pitfalls

[Dr. Alexa Levey]
I'm going to tell you. It's challenging. I've built both practices from scratch, honestly, without a lot of help, just with a lot of grit, a lot of making relationships. It just takes one relationship to get you started. I did the first Y-90 ever at Memorial Hermann Sugar Land. They didn't have it. In three months, I was able to do it, and I'm very proud of that. It's hard. When you go out to a place that doesn't know what you have, you have to give them a reason to support you.

With cryo, number one, they already had access to cryo in general. Normally the rep can just sit there and bring the machine, they can bring the probes, but there has to be a Lawson number, at least as far as Memorial Hermann goes, so that they can adequately bill for it. Then you have to show them, Okay, if I'm going to do this, am I going to use anesthesia? Am I not going to use anesthesia? Is the CT scan able to accommodate anesthesia cases? Does the CT scanner have CT fluoro? Because CT fluoro will cut down on the case time by 25%, and time is money. They can be scanning patients in those times, and those are adequate RBUs. How many probes am I going to be using? Am I going to do more cryoneurolysis versus tumor ablation, which I think those are two completely different things, and actually important to touch on as well. It's a hard thing to grasp that you don't need to do 10-8, 10-8, 10-8 for everything, that you can just do eight minutes and be done. Is there the correct anesthesia hookups? I think I already said that. Are we going to be able to bill for it? Is my private practice group going to be able to bill for the professional fee while the hospital bills for the technical fee? That was something I actually didn't even expect to cross. What is the actual take-home product? is it something that's profitable for the hospital?

I'm actually cringing and feeling knives go in my tummy as I talk about costs in patient care because you don't want to do it. I think it's gross, but it's very important because medicine is still a business. You can help people and still do something that is profitable for the hospital. You need to be able to show them that it is profitable for them to want to support you.

That is a Reader's Digest version of all the things that you need to think about when you're going into it. Now that I've been through it a couple times, it's definitely something that is totally feasible. Don't even mind the insurance and these T-codes. I thought the T-codes were fine and great. T-codes are not good if you're in private practice. There's a lot more work of what you have to do, which is why I'm now even more focused on trying to do research towards this. I just did a paper in JVIR on complex regional pain syndrome and cryoablation of the stellate ganglion, and it was a small group, but at least it's something. There's nothing getting published because it's so hard nowadays to do research as well as the things that people don't realize.