February 1, 2013

Current Concepts in Vertebral Augmentation

Dr. Morgan Lorio surveys the landscape of vertebral augmentation to find contentious studies and offers suggestions to educate the public and other practitioners. Morgan P. Lorio, MD, FACS Chair, ISASS Coding & Reimbursement Task Force The AAOS Clinical Practice Guidelines on the Treatment of Symptomatic Osteoporotic Compression Fractures, adopted in September 2010, were developed by a multidisciplinary volunteer work group and based on an algorithm that used level of evidence to rigorously qualify data. Two studies (2009) – by Buchbinder and Kallmes – were identified by AAOS to be Level I and were apparently determined to be a sufficient litmus test to diminish the importance of the mountain of Level II-IV evidence that suggested value to these procedures. A SpineLine […]
December 6, 2012

Federal AHRQ to Review Comparative Effectiveness for Spinal Fusion

Note: The public comment period for this has passed. Thank you for your input. Member Input Needed 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. A draft report and report appendix can be found here: Comment on Draft Reports and White Papers ISASS is encouraging our members to provide comments to AHRQ. AHRQ reports are not definitive policy for either Medicare/Medicaid or commercial insurers. However, commercial insurers oftentimes cite AHRQ reports to support their policies. AHRQ states that “The information in this report […]
November 2, 2012

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 assisted the AMA in determining the surgical valuation for 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 […]
September 25, 2012

ISASS Policy Statement – Cervical Total Disc Arthroplasty

ISASS Policy Statement – Cervical Total Disc Arthroplasty Symptomatic cervical disc disease (CDD) refractory to non‐surgical care is currently treated with anterior cervical discectomy and fusion (ACDF) with good clinical results reported1‐3. Fusion does however eliminate natural motion increasing stresses on adjacent levels, and progressive degeneration at the levels around the fusion has been reported. The rate of symptomatic adjacent segment degeneration (ASD) is estimated to occur at 3% per year and to be present in up to 25% of patients at 10 years4. The etiology for ASD is likely a combination of the altered biomechanical environment imposed by fusion and the patients’ underlying disc disease or genetic predisposition4,5. ASD after a prior cervical fusion is not a benign condition […]