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FOR IMMEDIATE RELEASE

 

Contact: Kristy Radcliffe

Phone: +1 (630) 375-1432

Email: Kristy@isass.org

 

Morgan Lorio, MD Highlights ISASS’ Advocacy Work

Aurora, Ill. – November 21, 2017 – Chair of the ISASS Coding & Reimbursement Task Force and winner of the 2017 ISASS Distinguished Service Award, Morgan Lorio, MD highlights the Society’s advocacy work over the past year.

“ISASS’ advocacy action takes many forms across multiple forums, but at the most basic level, our number one goal is to support spine surgeons and spine patients,” Lorio said. “We do this through education—educating our members on the most pressing issues facing our practice, educating regulators on the impact of regulations on the surgeon/patient relationship, and educating payers with the most up-to-date literature on surgical spine procedures and technologies.”

Since taking the helm of ISASS in April 2017, ISASS President Jeffrey Goldstein, MD has focused on expanding the Society’s advocacy efforts. “ISASS is well known for its high-quality educational courses and meetings,” Goldstein said, “but our members also benefit from our tireless advocacy work with regulators and payers to ensure our patients have access to the best surgical spine care.”

Here are just a few examples of ISASS’ advocacy at work over the past year:

  • ISASS successfully advocated for Anthem Blue Cross Blue Shield to retract coding edits bundling additional-level posterior/posterolateral fusions (22614) with the first-level procedure (22600, 22610, 22612, 22630, and 22633).
    • Background: Anthem BCBS announced coding edits in December 2016 bundling 22614 (arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (list separately in addition to code for primary procedure)) with 22600 (arthrodesis, posterior or posterolateral technique, single level; cervical below c2 segment), 22610 (arthrodesis, posterior or posterolateral technique, single level; thoracic (with lateral transverse technique, when performed)), 22612 (arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed)), 22630 (arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar) and 22633 (arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar). Anthem also announced that modifiers would not override the edit. These edits meant, effective March 1, 2017, surgeons would no longer be reimbursed by Anthem BCBS for additional level posterior/posterolateral fusions. ISASS objected to these proposed edits along with other existing Anthem coding edits in a letter to Anthem on January 31, 2017 and subsequently met with representatives from Anthem to request retraction. Anthem considered the Society’s request and retracted the edits in June 2017.
  • ISASS successfully advocated for the Centers for Medicare and Medicaid Services (CMS) and the National Correct Coding Initiative (NCCI) to retract planned coding edits to bundle anterior instrumentation codes 22845-22847 with 22859. CMS will allow the use of modifier 59 to report separate anterior instrumentation (22845-22847) unrelated to anchoring the device, with CPT codes 22853 and 22854.
    • Background: In the Fall 2016, NCCI released proposed procedure-to-procedure (PTP) coding edits with a proposed effective date of January 1, 2017 bundling 22845 (Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure)), 22846 (Anterior instrumentation; 4 to 7 vertebral segments (List separately in addition to code for primary procedure)), and 22847 (Anterior instrumentation; 8 or more vertebral segments (List separately in addition to code for primary procedure)) with 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 primary procedure)), 22854 (Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)) and 22859 (Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)) unless a modifier is used. This means that Medicare would no longer reimburse surgeons for the placement of separate anterior instrumentation with a biomechanical cage/device unless a modifier is used to override the edit. ISASS led a coalition of specialty societies to dispute these proposed edits and submitted a letter to NCCI on November 11, 2016. NCCI responded on December 13, 2016 that CMS would not implement coding edits bundling 22845-22847 with 22859, but would proceed with implementation of coding edits bundling 22845-22847 with 22853 and 22854 effective 04/01/17. ISASS and the coalition of specialty societies again wrote to NCCI and CMS on February 13, 2017 opposing implementation of these edits and ISASS met with representatives of CMS and NCCI in August 2017. CMS and NCCI responded on November 21, 2017 by clarifying that surgeons may use modifier 59 to report separate anterior instrumentation (22845-22847) unrelated to anchoring the device, with CPT codes 22853 and 22854.
  • After consideration of data gathered by ISASS in the form of two paired comparison surveys on the work involved in minimally invasive sacroiliac joint fusion (CPT code 27279), in the 2018 final Physician Fee Schedule rule, the Centers for Medicare and Medicaid (CMS) flagged CPT code 22729 as potentially misvalued and asked the Relative Value Scale Update Committee (RUC) to re-evaluate the code. CPT code 27279 is currently valued at 9.03 work RVUs, however data gathered by ISASS suggests this procedure is undervalued and should be valued at 14.23 work RVUs. ISASS will participate in the RUC process in the coming months to re-evaluate the code.
  • ISASS issued a policy statement on decompression with interlaminar stabilization to be used by the Society, surgeons and patients to inform payer coverage policies. ISASS has several new policy statements under development at this time.
  • ISASS joined Blue Cross Blue Shield Association’s Evidence Street Program in order to provide valuable feedback on the Association’s health technology assessments, which are used by the Blues plans to develop and update coverage policies.

“There is never a shortage of issues to address,” Lorio said, “and we are always looking for surgeons who want to contribute to ISASS’ advocacy efforts particularly related to coding, coverage, reimbursement and regulatory matters.” If you are interested in becoming a member of ISASS or becoming more involved in the Society, please email info@isass.org.

 

 

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