A recent convening of Alabama BCBS’ Medical Policy Group proposed a positive change to their policy on Minimally Invasive SI Joint Surgery to establish MIS SIJ fusion as medically necessary using an FDA-approved device (not specific to any one device type) when all of the following criteria are met: Pain is at least 5 on a 0 to 10 rating scale that impacts quality of life or limits activities of daily living; AND There is an absence of generalized pain behavior (e.g., somatoform disorder) or generalized pain disorders (e.g., fibromyalgia); AND Patients have undergone and failed a minimum six months of intensive non-operative treatment that must include medication optimization, activity modification, bracing, and active therapeutic exercise targeted at the lumbar spine, pelvis, sacroiliac joint, and […]
ISASS Coding and Reimbursement Task Force Chair Dr. Morgan Lorio participated in a meeting with officials from the Office of Management and Budget (OMB) to discuss reimbursement of minimally invasive spine surgery procedures in the Medicare Physician Fee Schedule. The meeting occurred March 19, 2019, and was focused on the undervaluation of spine surgical procedures in the Medicare Physician Fee Schedule. Dr. Lorio described two clear examples of mis-valuation of minimally invasive spinal procedure in CPT code 27279, Minimally Invasive Sacroiliac Joint Fusion, and 22867, Interlaminar Spinal Stabilization. The Centers for Medicare and Medicaid Services (CMS) have already identified as potentially misvalued in previous Medicare Physician Fee Schedules but have not changed the Relative Value Units (RVUs) for 27279. OMB […]
The International Society for the Advancement of Spine Surgery released two new statements: one focused on bone graft substitutes and the other examining vertebral augmentation. The bone graft substitute statement outlines historical use and U.S. regulatory pathways for bone grafts, including nonstructural allografts, demineralized bone grafts, cellular-based allografts, synthetic bone grafts, autologous cellular grafts and Class III drug-device combination products. “Bone grafting is an essential part of spinal surgery and ever-evolving science,” concluded the recommendation authors. “With each new advance, one needs to understand the characteristics of material, its mechanism of action, the regulatory pathway by which it came to market and the preclinical and human clinical evidence available on which to base a clinical use decision.” The authors found: Nonstructural cancellous allograft […]
Read the Spring 2019 issue of Vertebral Columns. In this issue: Reevaluating indications for cervical TDA, decreasing hospital stays, MIS options for pelvic fixation, maximizing lordosis, and a review of the literature surrounding PROMIS!