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Public Policy and Advocacy

August 2014 - ISASS Policy Statement - Minimally Invasive Sacroiliac Joint Fusion

The ISASS Coding and Reimbursement Task Force has been busy addressing our membership's needs while advocating spine access (further projects are in the pipeline). Our past MIS SIJ Policy was created early as MIS SIJ was evolving. The current body of literature is now more robust and a timely educational update for ISASS & IASP membership and will appear in an upcoming issue of the International Journal of Spine Surgery.

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June 2014 - ISASS Now a Member of AMA House of Delegates

Gunnar B.J. Andersson, MD, PhDToday after much hard work and diligence, ISASS was awarded a seat at the table of the House of Delegates (HOD) of the AMA. Gunnar Andersson, MD, PhD, ISASS President was handed a clicker and began voting on your behalf. "Today ISASS became a member of the AMA House of Delegates, this gives us a seat at the table of the organization that makes decisions at the [Current Procedural Terminology] and [Relative Value Scale Update] Committees," said Anderrson of this accomplishment.

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April 2014 - ISASS Responds to CBS Spinal Fusion Segment

CBS recently highlighted the fact that spinal fusions are increasingly common procedures and that indications in some cases are controversial. Their highlighting of "surgeons they looked into" presents a frightening picture of alleged abuses, of a procedure that in many cases is clinically indicated with excellent results.

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April 2014 - ISASS Policy Statement - Cervical Artificial Disc 2014

The ISASS Task Force reached out to Domagoj Coric, MD to provide a timely summation on cervical disc arthroplasty given his special interest and recent IASP championing of this innovative technology to ensure enhanced spine patient access. The ISASS Task Force is pleased with this step towards published ISASS societal policy and applauds Dr. Coric's effort; if ISASS is to continue to succeed we must continually harness the voluntary talents and energies of our members with gratitude.

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March 2014 - ISASS Statement on Coding Changes for Minimally Invasive SI Joint Fusion 2014

ISASS/IASP is fostering relationships with the payer community to keep them informed of guidelines that impact their members and policy decision making. ISASS/IASP continues to support access of medically necessary procedures to patients and support the spine practices of our member surgeons. The ISASS Statement on Coding Changes for Minimally Invasive SI Joint Fusion 2014 is another example.

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February 2014 - Introduction of SGR Repeal and Medicare Provider Payment Modernization Act of 2014

ISASS staff participated in a conference call conducted by the American Medical Association (AMA) in which the SRG Repeal Legislation was discussed. We felt ISASS members would want to review the information presented.

Staff for the chairmen and ranking minority members of the three Congressional committees of jurisdiction briefed physician groups this afternoon on the results of their bicameral, bipartisan negotiations on repealing the SGR. The “SGR Repeal and Medicare Provider Payment Modernization Act of 2014,” which was introduced by Rep. Michael Burgess, MD (R-TX) in the House as H.R. 4015, addresses only the policy provisions related to eliminating the flawed payment update formula. It does not include financial offsets or any of the usual extender policies.

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September 2013 - Spotlight on the Coding and Reimbursement Task Force

In response to continued downward pressure from government and commercial payers on spine surgery coverage and reimbursement, the ISASS Coding & Reimbursement Task Force continues to evaluate policies that may be detrimental to optimal patient care, and that may unnecessarily or punitively reduce physician reimbursement.

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September 2013 - Comments on CMS Proposed Rule (CMS-1600-P) – Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Medicare Part B for CY 2014

On behalf of the International Society for the Advancement of Spine Surgery (ISASS), I am writing to submit comments on the proposed Medicare Physician Fee Schedule (MPFS) for CY 2014. [...] Overall, we are very concerned with the proposal to cap payment rates for over 200 physician services at outpatient prospective payment system (OPPS) or ambulatory surgical center (ACS) rates. Such a proposal will reduce payment for some services by more than 50 percent, which will reduce or eliminate their utilization in physician offices, and will thus require patient to obtain such service in a more costly and less convenient setting.

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September 2013 - Comments on CMS Proposed Rule (CMS-1601-P) Section III(A) Regarding Changes to IDE Coverage Process

On behalf of the International Society for the Advancement of Spine Surgery (ISASS), below are comments submitted on CMS’ Proposed Rule, Revisions to Payment Policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule and Other Revisions to Part B for CY 2014.

ISASS is an international, scientific and educational society organized to discuss and assess existing strategies and innovative ideas in the clinical and basic sciences related to spine surgery to enhance patient care. Our comments focus specifically on proposed changes to the procedures and standards for Medicare coverage of items and services furnished during Investigational Device Exemption (IDE) clinical trials.

As a professional society dedicated to the treatment of spine disorders, our members often participate in prospective IDE clinical studies to evaluate the safety and clinical efficacy of new or emerging technologies or procedures. The proposed changes to the Medicare coverage process for these studies threaten the timely enrollment and execution of clinical trials, particularly with respect to spinal technologies. Below, we describe our concerns with the proposed changes and offer recommendations to better protect important clinical research.

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July 2013 - Statement on Coding Changes for Minimally Invasive SI Joint Fusion

ISASS supports decision making at the physician-patient level based on medical necessity and achieving the best outcomes to address the patient’s medical condition. Medical necessity should not be determined by a mere administrative code reporting system such as CPT. Prior to the July 1st implementation of CPT category III code 0334T, surgeons reported and were reimbursed for ALL sacroiliac joint fusion procedures when medically necessary, including minimally invasive, through the use of CPT code 27280.

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May 2013 - Domagoj Coric, MD Responds to BCBSNC “Let’s Talk Cost” Statement on Artificial Discs

I am writing you on behalf of International Advocates for Spine Patients (IASP) as well as the patient population of North Carolina. IASP is an organization supported by physicians and patients dedicated to advocacy for high quality, widely accessible and cost effective spine care for patients around the world. I am on the Board of IASP (a sister organization to the International Society for the Advancement of Spine Surgery-ISASS) which was formed in 2011 to complement ISASS’ educational and scientific mission through direct advocacy efforts on the behalf of spine patients. I have spent the last 30 years in NC, generally working in healthcare or related fields. [...] I am writing to express serious concerns about numerous factual inaccuracies and omissions on the Blue Cross Blue Shield of North Carolina “Let’s Talk Cost” web site.

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March 2013 - ISASS Statement on Vertebral Augmentation

To: ISASS Members and the General Spine and Medical Communities

It is estimated that over 1.4 million people will develop vertebral compression fractures every year (Johnell & Kanis 2006).  Many will be clinically insignificant or heal with non-operative treatment.  A large group will have persistent pain, kypholic deformity, weight loss, depression and a reduced quality of life.  (Old & Calvert 2004; Borgstrom et al. 2006; Suzuki et al. 2008).

Open surgical intervention is used when there is severe deformity, instability, or neurologic compromise. Vertebral augmentation such as Vertebroplasty (VP) and balloon kyphoplasty (BKP) are minimally invasive techniques used to treat painful vertebral compression fractures.  There is good evidence that these techniques can provide immediate and lasting pain relief (Berlemann et al. 2004; Grafe et al. 2005; Groh et al. 2005; Alvarez et al. 2006; DeNegri et al. 2007; Lovi et al. 2009; Schofer et al. 2009; Wardlaw et al. 2009; Klazen et al. 2010; Liu et al. 2010; Santiago et al. 2010; Boonen et al. 2011).  At the same time there is evidence that not all patients with vertebral compression fractures benefit from these procedures (Buchbinder et al. 2009; Kalmes et al. 2009; Rousing et al. 2009; Wardlaw et al. 2009; Klazan et al. 2010).  Technology assessment efforts and meta-analyses have arrived at different conclusions regarding the value of vertebral augmentation, but are based on different studies depending on the timing of analyses and publications (Taylor et al. 2006a,b; Hulme et al. 2006; Eck et al. 2007; AAOS 2010; Papanastassiou et al. 2011).

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December 2012 - Advocacy Alert: Member Input Needed: Federal AHRQ to Review Comparative Effectiveness for Spinal Fusion

The US Agency for Healthcare Quality and Research (AHRQ) has taken up a comparative effectiveness review of "Spinal Fusion for Treating Painful Lumbar Degenerated Discs or Joints." They recently released a draft report and have provided a public comment period with a deadline of December 18, 2012. ISASS is encouraging our members to provide comments to AHRQ.

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November 2012 - Advocacy: 2013 Physician Fee Schedule Finalized - CMS Assigns Valuation to Pre-Sacral Fusion Code

ISASS Thanks our Members for Stepping Up

On November 1st, the Centers for Medicare & Medicaid Services (CMS) released the 2013 Medicare Physician Fee Schedule final rule.

Of particular note to ISASS members is CMS' decision to assign a valuation ('relative value units') to a recently approved Category I CPT® code 22586: pre-sacral interbody fusion at L5-S1. Earlier this year, ISASS supported the transition of this procedure code to Category I status from its Category III status since the procedure had satisfied the criteria necessary for such a code transition. After the Editorial Panel had voted in favor of establishing the Category I code for pre-sacral interbody fusion, other spine-related medical societies declined to participate in a member RUC survey to establish physician valuation for the procedure. ISASS however realized the importance of appropriately valued procedures to its spine surgeon members, and agreed to conduct a survey of our members to collect the appropriate data for CMS to establish valuation for this procedure.

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October 2012 - Advocacy: ISASS Joins the AMA and 100+ Medical Societies in SGR Transition Principles Letter

The AMA and more than 100 state and medical specialty societies - including ISASS - issued a set of principles that can support a federal transition from the sustainable growth-rate formula to a “higher performing Medicare program.” In an Oct. 15 letter to Congressional Leaders, the groups called for lawmakers to repeal the Medicare physician payment formula, arguing that eliminating the SGR formula is essential to the development of a high performing Medicare program.

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September 2012 - Advocacy Alert: Washington State Health Care Authority Seeking Input on Cervical Spinal Fusion for DDD

The office of Health Technology Assessment in the state of Washington has commissioned a health technology assessment of cervical spinal fusion for degenerative disc disease, in order to compare the clinical benefits, potential harms, and economic impact of cervical fusion procedures to conservative management and other treatment alternatives.

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July 2012 - The Spine Movement - Spine ASCs and Meeting The Existence Theorem

From the June 2012 Special ASC Issue of the ISASS monthly newsletter The Spine Movement:

Dr. Morgan Lorio, Chair of the ISASS Coding & Reimbursement Task Force tackles a few of the larger issues in spine ambulatory surgery.

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June 2012 - The Spine Movement - Coding Challenges Loom Large in 2012

From the June 2012 Special Advocacy Edition of the ISASS monthly newsletter The Spine Movement:

Dr. Morgan Lorio, Chair of the ISASS Coding & Reimbursement Task Force, gives a look at concrete examples of the increasingly difficult environment for spinal procedures.

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June 2012 - The Spine Movement - Important Changes to the CPT Coding of Minimally Invasive Surgery

From the June 2012 Special Advocacy Edition of the ISASS monthly newsletter The Spine Movement:

Dr. Choll Kim examines the ever trickier coding landscape as it relates to Minimally Invasive Surgery.

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June 2012 - ISASS Response to US Supreme Court Ruling on PPACA

In response to the US Supreme Court's ruling on the constitutionality of the Patient Protection and Affordable Care Act (PPACA), ISASS President Steven Garfin, MD has issued the following statement:

ISASS remains committed to working on behalf of our US-based spine surgeons to ensure that the PPACA is implemented in ways that ensure our patients' access to medically indicated and appropriate spine surgeries and procedures....

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June 2012 - Advocacy Alert: New York Spine Surgeons - Action Required

Legislation is pending in NY that will require out-of-network reimbursement rates to be tied to properly established UCR rate calculations (as opposed to inadequate bench-marking information). The New York State Society of Orthopaedic Surgeons (NYSSOS), together with the Medical Society of the State of New York (MSSNY), is seeking advocacy input from all NY-based spine surgeons and related health care professionals, scientists and researchers.

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June 2012 - ISASS Coding & Reimbursement Task Force Member Barbara Cataletto writes "6 Months Later – How Are You & the New Spine Codes Doing?" for Becker's Spine Review

"So now we are months into the new CPT code changes for spine for 2012. If you were able to get this far without losing your mind or quitting your job, then you must be a real trooper! There have been so many issues surrounding the implementation of these codes in all sectors of the industry. Practices need to adjust op notes, authorizations and coding programs."

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May 2012 - The Spine Movement: The Big Picture: ISASS Advocacy Efforts

From the May 2012 Special Advocacy Edition of the ISASS monthly newsletter The Spine Movement:

David Porter - ISASS Director of Public Policy & Advocacy - discusses the history, future, and many directions of ISASS work on helping surgeons receive appropriate reimbursement and helping patients receive the best possible care.

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May 2012 - The Spine Movement: Stepping Up, State by State

From the May 2012 Special Advocacy Edition of the ISASS monthly newsletter The Spine Movement:

Gunnar Andersson, MD, PhD - ISASS Board of Directors - points out that pushing for policy isn't that different from your practice: as always, the patient's well-being is the first concern.

"There's no question in my mind that we are stronger as a group than we are as individuals... we need to unify in ISASS and make our voice heard both on a national and local level."

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May 2012 - Advocacy Alert Update: Official ISASS Response to HCSC Draft Policy

ISASS President Steven Garfin, MD, submitted the official ISASS response to HCSC, the parent corporation for Blue Cross/Blue Shield plans in Illinois, New Mexico, Oklahoma, and Texas, and the new draft policy for Lumbar Spinal Fusions. "With the promulgation of this policy, those patients may now lose the opportunity of a clinically meaningful improvement. Given that all patients are different, sweeping policy statements will exclude properly selected patients from receiving appropriate clinical care."

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May 2012 - ISASS Launches IASP Website at SpinePatientAdvocacy.org

ISASS is pleased to announce that the website for our new advocacy organization International Advocates for Spine Patients is now open.

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May 2012 - Advocacy Alert Update: ISASS President Steven Garfin, MD Rebuts HCSC/BCBSIL Draft Policy Changes for Lumbar Spinal Fusion Surgery

ISASS President Steven Garfin rebuts the HCSC/BCBSIL draft policy changes noted in last week's advocacy alert. "While many patients with degenerative disc disease or facet syndrome will not have that diagnosis as their sole indication, there are patients with chronic low back pain who have not responded to appropriate non-operative treatment and who will benefit from a surgical procedure. Those patients may now lose the opportunity of a clinically meaningful improvement."

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May 2012 - Advocacy Alert: HCSC Drafts New Policy for Lumbar Spinal Fusions

Earlier this week, HCSC, the parent corporation for Blue Cross/Blue Shield plans in Illinois, New Mexico, Oklahoma, and Texas, issued a new draft policy for Lumbar Spinal Fusions. Concerns have been raised that this new policy rules out access to lumbar fusion for patients where the sole indication is a disc herniation or neurostructure compression (initial discectomy / laminectomy), and patients with a sole indication of degenerative disc disease or facet syndrome. ISASS is preparing a response to HCSC and recommends that spine surgeons in those states review the draft policy and respond at the local level before the May 31, 2012 deadline.

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May 2012 - ISASS Presentation to Simmons Surgical Society by David Porter

Presentation by David B. Porter, ISASS/IASP Director of Public Policy and Advocacy, describing advocacy efforts for spine surgeons and patients, the "Trident" of Advocacy and more at the Simmons Surgical Society 33 Annual Meeting.

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April 2012 - Advocacy Alert: ISASS Letter to CMS Division of Outpatient Care Regarding the Removal of Cervical Disc Arthroplasty from the Medicare "Inpatient Only" List

ISASS President Steven Garfin, MD, has written a response to the Centers for Medicare & Medicaid Services Division of Outpatient care regarding the agency considering the removal of cervical disc arthroplasty from the Medicare "Inpatient Only" list.

"ISASS supports Medicare policies that will help spine surgeons deliver better and novel treatments to our patient population.  Our experiences have shown us that cervical disc arthroplasty in selected patients can be safely performed in the outpatient setting, just as cervical fusion is now being conducted."

Read the Full ISASS Letter to CMS Division of Outpatient Care »

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March 2012 - Advocacy Alert: BCBS Minnesota Revises BMP Medical Policy IV-85

Orthopedics This Week is reporting that the Scoliosis Research Society and ISASS advocacy efforts regarding BMP Medical Policy IV-85 have resulted in review and change of their controversial policy. BCBS Minnesota "has rescinded a recent controversial policy of denying payment for ANY part of a surgery if BMPs are used off-label. [....] BCBS's Vice President and Chief Medical Officer, Greg Gilmet, M.D., M.P.H., made good on the promise to consider revisions and informed SRS that the previous controversial policy was, 'reviewed, modified, and posted,' on the company's website, effective March 9, 2012."

Read More at Orthopedics This Week »

See Also:

Advocacy Alert: ISASS to Support SRS Response to BCBS Minnesota Medical Policy IV-85

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March 2012 - Advocacy Alert: ISASS Joins 370 Organizations in Calling for Repeal of IPAB

ISASS has signed a letter with hundreds of other organizations, expressing support for the complete repeal of the Independent Payment Advisory Board, which was included in the Patient Protection and Affordable Care Act legislation. "We all share the conviction that the Independent Payment Advisory Board (IPAB) will not only severely limit Medicare beneficiaries’ access to care but also increase healthcare costs that are shifted onto the private sector."

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March 2012 - Advocacy Alert: ISASS Comments to AHRQ - Spinal Fusion for DDD or Joint Disease

"We welcome the opportunity to comment on the key questions AHRQ might pose as they undertake a review of spinal fusion for lumbar degenerative disc or joint disease. As a scientific, educational and advocacy organization, we remain committed to insure that subsequent AHRQ recommendations around lumbar spinal fusions for degenerative disc or joint disease do not unfairly or unnecessarily limit patient access to medically indicated surgeries that can improve patient outcomes, reduce or eliminate chronic pain, and accelerate a patient’s return to a satisfying and productive life."

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February 2012 - Advocacy Alert: ISASS to Support SRS Response to BCBS Minnesota Medical Policy IV-85

ISASS will be co-signing with The Scoliosis Research Society (SRS) on the response to Blue Cross Blue Shield of Minnesota's Medical Policy IV-85 for "Bone Morphogenic Protein". The policy severely restricts patient access to BMP. The SRS has called for support from spine societies to contribute to the letter.

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February 2012 - Advocacy Alert: Doc Fix Tentative Deal Reached

The LA Times is reporting that federal lawmakers have reached a tentative agreement today on a payroll tax holiday bill to avert a 27%+ cut in Medicare physician payment rates. The agreement would extend the current rates through the end of 2012. ModernHealthCare.com is reporting that the agreement also extends certain Medicare programs while making $11+ billion in cuts to the Patient Protection and Affordable Care Act.

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February 2012 - Advocacy Alert: New Jersey State Spine Society Emergency Meeting

Dr. Mitchell Reiter, President NJSSS, has called for an emergency meeting to be held on on February 15, 2012 at the Sheraton Tara Hotel, 199 Smith Road, in Parsippany, New Jersey. Major issues have arisen from proposals by Horizon Blue Cross and Blue Shield of New Jersey and Cigna that will dramatically reduce reimbursement rates for spine procedures. The meeting is being held to collect input and activate spine surgeons in New Jersey to address this direct and specific attack on spine procedure reimbursement.

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February 2012 - Video: Dr. Morgan Lorio's AHRQ Testimonial

ISASS Coding and Reimbursement Task Force Chair Morgan Lorio, MD has posed a video testimonial response to the AHRQ: Comments on Key Questions:

"On July 12, 1982 at 10am I fell approximately 35 feet at work from scaffolding and literally broke my back. I recovered from the fractures but suffered from an insidious onset of low back degenerative disc disease. This problem was underscored in 1997 as I required an L5/S1 diskectomy for left leg radiculopathy. My leg pain was greatly improved but my back pain worsened. By 2005 I was wearing a TENS unit ramped up to the maximum and requiring cortico-steroids and anti-inflammatory treatments to have anything akin to a normal life."

Read More / Watch Video »

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February 2012 - Advocacy Alert: Call to Action from ISASS Coding and Reimbursement Task Force Chair Morgan Lorio, MD

"It has been brought to my attention that YOUR IMMEDIATE ACTION IS REQUIRED regarding a time sensitive notice issued by the Agency of Healthcare Research and Quality (AHRQ). Summarized, AHRQ has requested comments on spinal fusion for painful lumbar degenerative disc or joint diseases. It is our timely duty, and it is imperative that we respond with a strong front supporting the care of our spinal patients. As spinal surgeons, we must be actively involved in this worthy endeavor.

"I STRONGLY ENCOURAGE YOUR ACTION. ISASS will forward a statement with the ISASS Lumbar Fusion Policy Statement. I plan to formulate my own testimonial this week in both written and YouTube format. I implore each of you to act as well – every spinal surgeon member should send any support letter, article, case experience, and/or testimonial available to AHRQ."

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Related Links:

AHRQ: Comments on Key Questions

ISASS Policy Statement on Lumbar Fusion Surgery

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January 2012 - ISASS Coding and Reimbursement Task Force

"The ISASS Board is pleased to announce that Morgan P. Lorio, MD, FACS, of Bristol, Tennessee, will chair the new Coding & Reimbursement Task Force. Dr. Lorio is in private practice, and also is an assistant clinical professor at East Tennessee State University."

"The Coding & Reimbursement Task Force is charged with: 1.) identifying spinal surgery-related coding and reimbursement issues that may adversely impact patient access to medically indicated spine surgeries; 2.) developing for the Board's approval advocacy action plans on the society's behalf to address those issues; and, 3.) assisting in the execution of those advocacy actions plans as appropriate and necessary."

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