Rapid Response and Coding Policy Update
NREF “Honor Your Mentor” Funds Honor Your Mentors – Section
What’s up with the RUC?
Interim Safety and Efficacy Findings from the SCiStar Study
Interview with Outgoing DSPN Chair, Jack Knightly
Interview with Eric Zager
Parsonage-Turner Syndrome: An Oft-forgotten Member of the Differential Diagnosis
Updates for DSPN Members
In this issue, Rick Fessler gives us an overview of very exciting preliminary results from the ongoing Asterias clinical trial for stem cell transplantation in spinal cord injury. Cheerag Upadhyaya interviews our outgoing Section Chair, Jack Knightly on the eve of the Spine Summit in Las Vegas. Line Jacques speaks with Eric Zager on advances in peripheral nerve care and technology. Also from the Peripheral Nerve corner, Zack Ray and Thomas Wilson offer an excellent and concise review of Parsonage-Turner Syndrome. John Ratliff provides an update from the RUC, and Kurt Eichholz gives us an overview of recent payor and policy issues.
The Rapid Response Committee continues to work aggressively to protect patient access to appropriate spine care. Two issues been recent focuses of the committee in an effort to maintain proper access and proper payer interpretation of coding.
Cervical arthroplasty has been FDA approved for almost a decade. However, for the first several years, cervical arthroplasty was coded with a category III code. As a reminder, Category III codes are tempo- rary codes for to allow for data collection and track utilization of new and emerging technology, whereas Category I codes are used for procedures which are consistent with standard medical practice, and are widely performed. While a device may be FDA approved, it may have a category III code. In most cases, this becomes an impetus for
payers to consider the device“experimental and not medically necessary.” The category III code for cervical arthroplasty limited widespread utilization of the procedure for many years until enough data was published in the literature, and a category I code was obtained. Since then, cervical arthroplasty has become more widespread, and is now part of the medial policy for most payers.
While cervical arthroplasty, which has been studied extensively since its IDE studies in the mid-2000’s, has achieved acceptance by payers and a category I CPT code, the code for revision of cervical arthroplasty has remained a category III code (0095T). Considering that the proto- typical patient undergoing cervical arthroplasty is young, with one or two soft disc herniations, and minimal degenerative or spondylytic disease, it is not unexpected that the number of revisions of cervical arthroplasty devices would be small. However, as with any treatment, there will be failures, although rare. Since initial cervical arthroplasty is considered a standard and accepted procedure, the revision should also achieve a category I code for those indicated cases.