Referring a patient
I work closely with providers across Colorado and the Mountain West. I want referrals and communication to be simple.
Please specify “Dr. Mian.” I review every referral personally.
CarePoint Neurosurgery referral fax line.
I'll give you my direct contact information.
What to send
- Your diagnosis and/or the question you'd like me to answer.
- Recent clinic notes.
- Point us to the imaging and we'll take care of getting it.
- Always appreciated: information regarding disease-specific medication trials and other testing, detailed below.
Insurance
- I don't accept Medicaid or Tricare.
- Medicare/managed Medicare is accepted only for movement disorders and trigeminal neuralgia.
- HMO plans require a referral from the patient's PCP.
Early conversations are welcome
A referral doesn't commit your patient to surgery. I'll tell you and the patient what the options are, including when non-surgical management is preferred. Patients needing more workup or those who are interested in a diagnosis or an educational visit are welcome, and they will meet my PA.
Suggested criteria and timing by disorder
Movement disorders
Diseases
Essential tremor. Tremor that interferes with everyday activities despite trials of two medications, ideally propranolol and/or primidone.
Parkinson's disease. Motor fluctuations (wearing off or dyskinesias), or tremor or other symptoms that are poorly controlled with dopaminergic therapy. It is rare to consider surgery within the first 3 years after diagnosis.
Dystonia. Trials of an oral muscle relaxant and Botox.
Therapies
Focused ultrasound. I will coordinate the skull screening. The procedure is covered by all carriers for essential tremor, except UHC commercial plans. Focused ultrasound is not covered by any carrier (including Medicare) for Parkinson's or dystonia.
DBS. Neuropsychological testing is always necessary, and we can coordinate. Patients with Parkinson's also need a levodopa sensitivity challenge (UPDRS-III, ON and OFF).
Battery replacements. Please specify the manufacturer, the voltage or lifespan, and the current settings in your note.
Facial pain
Trigeminal neuralgia and glossopharyngeal neuralgia. Trials of two or more medications, ideally including oxcarbazepine or carbamazepine. Other options include lamotrigine, gabapentin, baclofen, and pregabalin. I do not manage medications.
Hemifacial spasm. A trial of Botox.
An MRI of the brain with a thin-cut T2 sequence through the brainstem (CISS, FIESTA, or similar), not an MRA. My team can arrange one, if needed. A “negative” MRI does not preclude surgery.
Cervical spine
Neck pain, radiculopathy, or myelopathy. MRI and X-rays are appreciated. I can coordinate physical therapy and injections. I'll tell your patient whether surgery or conservative therapy is recommended, and if surgery, whether a decompression, disc replacement, or fusion fits best.
Epilepsy
Focal epilepsy. Ongoing seizures despite two medication trials, or any seizures with a structural lesion (e.g. cavernous malformation). Patients needing an EMU visit will be referred to Swedish. I work closely with the Swedish epileptology team, including discussing your patient at our multidisciplinary epilepsy surgery conference. Your virtual participation is welcome, but not expected.
Generalized epilepsy. I offer centromedian thalamic RNS off-label. I implant more RNS systems than any other surgeon in Colorado, and I'm glad to talk through whether a patient might be a candidate before a referral.
Brain tumors
New or growing tumors, including meningiomas, gliomas, metastases, and cavernous malformations, and requests for a second opinion. I don't treat pituitary tumors or certain skull-base lesions, but I can suggest specialists. I can coordinate oncology care or take over imaging surveillance, if needed.
I will implant using the manufacturer you and your patient prefer. You can program your own patient or, if you like, I can connect your patient with a specialist for programming. If you plan to program, I will alert you when the patient has been implanted and summarize pertinent details from the procedure to inform your first programming session.
I'm happy to speak to your practice, hospital, or patient support group. Email me directly or reach out to my MA at MDMian@carepointhc.com.