On July 13, 2017, the Centers for Medicare & Medicaid Services (CMS) released the 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy changes, quality provisions, and payment rates proposed rule. CMS is accepting comments on the proposed rule through September 11, 2017. The final rule is expected to be released by November 1, 2017. (Please note that physician payment is made under the Physician Fee Schedule; hospitals are paid for outpatient services under the OPPS and ASCs are paid under the ASC payment system, both detailed in this rulemaking.) Please see the spine code spreadsheet for a comprehensive comparison of reimbursements for spine procedures in both the Hospital Outpatient and ASC settings from […]
On July 13, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2018. The PFS pays for services furnished by physicians and other practitioners in all sites of service. These services include but are not limited to visits, surgical procedures, diagnostic tests, therapy services, and specified preventive services. CMS will accept comments on the proposed rule until September 11, 2017, and will issue the final rule by November 1, 2017. As part of the proposed rule, CMS issues proposed values for new codes and codes deemed misvalued. Please see the spine code spreadsheet […]
On March 24, ISASS sent a letter to the Work Loss Data Institute requesting an update to the outdated Official Disability Guidelines for Sacroiliac Joint (SIJ) pain. ISASS takes issue with the current guidelines which support minimally invasive sacroiliac joint (MIS SIJ) fusion for conditions such as SIJ infection, tumor, and spondyloarthropathy, conditions for which high-quality evidence supporting superiority over non-surgical treatment is completely lacking. The guidelines dismiss two high-quality randomized trials in patients with chronic SIJ dysfunction showing superiority of MIS SIJ fusion over non-surgical treatment. ISASS requests revision of the guidelines to better reflect the level of available evidence and to follow standard scientific approaches to evidence interpretation. Click here to view the letter.
News and noteworthy information for January 2017: A Closer Look at Biomechanical Device Coding MACRA/QPP Survey Global Surgery Data Collection Program Finalized Judge Blocks Aetna-Humana Merger Price Testifies at Senate Confirmation Hearings ICD-10 Code Updates and Impact to PQRS FDA Reclassifies Pedicle Screw Systems A Closer Look at Biomechanical Device Coding Effective January 1, 2017, CPT® code 22851was deleted from the CPT code set and replaced by three new codes to report insertion of biomechanical devices: CPT Code 22853 – Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for […]