Kern Singh, MD
Minimally Invasive Spine Insitute, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
Sheeraz Qureshi, MD, MBA
Department of Orthopaedic Surgery, Mt. Sinai Hospital, New York City, NY
This paper was originally published here.
A PDF version of this Policy Statement can be accessed here.
By: Morgan Lorio, MD, FACS, Chair, ISASS Task Force on Coding & Reimbursement
In 2011, CPT code 22551 was revised to combine or bundle CPT codes 63075 and 22554 when both procedures were performed at the same site/same surgical session. The add on code +22552 is used to report each additional interspace. 2014 heralded a downward pressure on this now prime target code (for non-coverage?) 22551 through an egregious insurer attempt to redefine cervical arthrodesis, effectively removing spine surgeon choice and altering best practice without clinical evidence. Currently, spine surgeons are equally split on the use of allograft versus cages for cervical arthrodesis. Structural allograft, CPT code 20931, is reported once per same surgical session, regardless of the number of allografts used. CPT code 22851 which is designated solely for cage use, has a higher reimbursement than structural allograft, and may be reported for each inner space. Hence, the rationale behind why some payers wrongly consider “spine cages NOT medically necessary for cervical fusion.” A timely consensus paper summarizing spine surgeon purview on the logical progressive evolution of cervical interbody fusion for ISASS/IASP membership was strategically identified as an advocacy focus by the ISASS Task Force. ISASS appreciates the authors’ charge with gratitude. This article has both teeth and transparent clinical real-world merit.
As we move to a more value-derived coverage analysis of surgical procedures, it is important to consider the changing definition of value and its impact on surgical innovation. Perhaps nowhere is this more apparent than in the evolution of anterior cervical discectomy and fusion (ACDF). While no one would argue that an ACDF has been a successful procedure since its inception over half a century ago, surgeons have continued to refine this technique in order to achieve the greatest success with the least patient morbidity. As such, it is this decision to not cover the use of cervical intervertebral cages in ACDFs that is so concerning to spinal surgeons. We appreciate the opportunity to present our comments on behalf of the International Society for the Advancement of Spinal Surgery (ISASS) and spinal surgeons everywhere, with the hope that this adverse decision will be reversed and coverage for this important technology will be maintained.