February 26, 2019

Centers for Medicare and Medicaid Services (CMS) Make Hospital Charges Available to the Public

For the first time, the federal government has made public chargemaster data for the 100 most common Medicare inpatient diagnostic related groups or DRGs. The data show that hospital prices often vary widely, even within the same within the same city or region. The massive file contains chargemaster data, or what some call the “sticker price,” for the 100 most common Medicare inpatient DRGs. The data does not include physician costs and does not show prices paid by Medicare. But it does provide an inside look at how average covered Medicare charges can significantly vary from hospital to hospital within the same city or geographic area. The data is for 3,400 hospitals and represents 92% of all hospital inpatient charges in […]
February 26, 2019

ISASS Meets with CMS Officials Regarding Reimbursement of Minimally Invasive Spine Surgery

ISASS Coding and Reimbursement Task Force Chair Dr. Morgan Lorio participated in a meeting with officials from Centers for Medicare & Medicaid Services, or CMS, to discuss reimbursement of minimally invasive spine surgery procedures in the Medicare Physician Fee Schedule.  The meeting occurred February 6, 2019, and was focused primarily on CPT code 27279, Minimally Invasive Sacroiliac Joint Fusion, which CMS has identified as potentially mis-valued in previous Medicare Physician Fee Schedules. CMS was represented by Director Carol Blackford; Ing-Jye Cheng, deputy director for the Office of the Department of Hospital and Ambulatory Policy Group (HAPG); and other officers in the Outpatient Care, Practitioner Services and Ambulatory Services Divisions, including Gift Tee, acting director of the Division of Practitioner Services, […]
February 13, 2019

Vertebral Augmentation: Coverage Indications, Limitations, and/or Medical Necessity

Vertebral Augmentation: Coverage Indications, Limitations, and/or Medical Necessity OLIVIER CLERK-LAMALICE,1 DOUGLAS P. BEALL,2 KEVIN ONG,3 MORGAN P. LORIO4 1Western Canada Pain Institute, Edmonton, Alberta, Canada, 2Clinical Radiology of Oklahoma, Edmond, Oklahoma,3Exponent, Inc., Philadelphia, Pennsylvania, 4Hughston Clinic Orthopaedics—Centennial, Nashville, Tennessee ABSTRACT The ISASS Policy Statement on vertebral augmentation has the objectives to provide a background and an update with the latest clinical evidence for the international spine community. A SpineLine Panel Review (2010) appropriately recommended an exploration of ‘‘the seeming disconnect between the conclusions of . . . two [Level I] PRCT’s and previous experience and data’’ regarding vertebral augmentation. ISASS responded by supporting a comprehensive meta-analysis to help frame a cogent historical analysis of vertebral augmentation. This ISASS Policy 2018 […]
January 30, 2019

ISASS Recommendations and Coverage Criteria for Bone Graft Substitutes used in Spinal Surgery

ISASS Recommendations and Coverage Criteria for Bone Graft Substitutes used in Spinal Surgery CELESTE ABJORNSON, PHD,1 ANTONIO BRECEVICH, MD,1 TUCKER CALLANAN, MS,1 CHRISTINA DOWE, BS,1 FRANK P. CAMMISA, JR, MD,1 MORGAN P. LORIO, MD, FACS2 1Hospital for Special Surgery, New York, New York, 2Hughston Clinic Orthopaedics, Nashville, Tennessee   INTRODUCTION Over the past 3 decades, there has been an increased interest in bone grafting materials as these materials have become a vital part of most spinal procedures. Unlike other areas of orthopedics, spinal surgery often requires grafting procedures to induce de novo bone in an area stabilized by metal devices. When considering potential graft materials, assuming an adequate blood supply, it is important to note that a successful graft needs […]