The ISASS Coding and Reimbursement Task Force has been busy addressing our membership's needs while advocating spine access (further projects are in the pipeline). Our past MIS SIJ Policy was created early as MIS SIJ was evolving. The current body of literature is now more robust and a timely educational update for ISASS & IASP membership has been developed.
Baxano Surgical has a support line for patients as well as an informational page on their devices. This support would be for patients that would benefit from or have experienced relief through Baxano devices. There are case managers that help with their appeals and walk patients through the process.
Today after much hard work and diligence, ISASS was awarded a seat at the table of the House of Delegates (HOD) of the AMA. Gunnar Andersson, MD, PhD, ISASS President was handed a clicker and began voting on your behalf. "Today ISASS became a member of the AMA House of Delegates, this gives us a seat at the table of the organization that makes decisions at the [Current Procedural Terminology] and [Relative Value Scale Update] Committees," said Anderrson of this accomplishment.
CBS recently highlighted the fact that spinal fusions are increasingly common procedures and that indications in some cases are controversial. Their highlighting of "surgeons they looked into" presents a frightening picture of alleged abuses, of a procedure that in many cases is clinically indicated with excellent results.
The ISASS Task Force reached out to Domagoj Coric, MD to provide a timely summation on cervical disc arthroplasty given his special interest and recent IASP championing of this innovative technology to ensure enhanced spine patient access. The ISASS Task Force is pleased with this step towards published ISASS societal policy and applauds Dr. Coric's effort; if ISASS is to continue to succeed we must continually harness the voluntary talents and energies of our members with gratitude.
ISASS/IASP is fostering relationships with the payer community to keep them informed of guidelines that impact their members and policy decision making. ISASS/IASP continues to support access of medically necessary procedures to patients and support the spine practices of our member surgeons. The ISASS Statement on Coding Changes for Minimally Invasive SI Joint Fusion 2014 below is another example.
ISASS staff participated in a conference call conducted by the American Medical Association (AMA) in which the SRG Repeal Legislation was discussed. We felt ISASS members would want to review the information presented.
Staff for the chairmen and ranking minority members of the three Congressional committees of jurisdiction briefed physician groups this afternoon on the results of their bicameral, bipartisan negotiations on repealing the SGR. The “SGR Repeal and Medicare Provider Payment Modernization Act of 2014,” which was introduced by Rep. Michael Burgess, MD (R-TX) in the House as H.R. 4015, addresses only the policy provisions related to eliminating the flawed payment update formula. It does not include financial offsets or any of the usual extender policies.
In response to continued downward pressure from government and commercial payers on spine surgery coverage and reimbursement, the ISASS Coding & Reimbursement Task Force continues to evaluate policies that may be detrimental to optimal patient care, and that may unnecessarily or punitively reduce physician reimbursement.
On behalf of the International Society for the Advancement of Spine Surgery (ISASS), I am writing to submit comments on the proposed Medicare Physician Fee Schedule (MPFS) for CY 2014. [...] Overall, we are very concerned with the proposal to cap payment rates for over 200 physician services at outpatient prospective payment system (OPPS) or ambulatory surgical center (ACS) rates. Such a proposal will reduce payment for some services by more than 50 percent, which will reduce or eliminate their utilization in physician offices, and will thus require patient to obtain such service in a more costly and less convenient setting.
On behalf of the International Society for the Advancement of Spine Surgery (ISASS), below are comments submitted on CMS’ Proposed Rule, Revisions to Payment Policies under the Physician Fee Schedule, Clinical Laboratory Fee Schedule and Other Revisions to Part B for CY 2014.
ISASS is an international, scientific and educational society organized to discuss and assess existing strategies and innovative ideas in the clinical and basic sciences related to spine surgery to enhance patient care. Our comments focus specifically on proposed changes to the procedures and standards for Medicare coverage of items and services furnished during Investigational Device Exemption (IDE) clinical trials.
As a professional society dedicated to the treatment of spine disorders, our members often participate in prospective IDE clinical studies to evaluate the safety and clinical efficacy of new or emerging technologies or procedures. The proposed changes to the Medicare coverage process for these studies threaten the timely enrollment and execution of clinical trials, particularly with respect to spinal technologies. Below, we describe our concerns with the proposed changes and offer recommendations to better protect important clinical research.
ISASS supports decision making at the physician-patient level based on medical necessity and achieving the best outcomes to address the patient’s medical condition. Medical necessity should not be determined by a mere administrative code reporting system such as CPT. Prior to the July 1st implementation of CPT category III code 0334T, surgeons reported and were reimbursed for ALL sacroiliac joint fusion procedures when medically necessary, including minimally invasive, through the use of CPT code 27280.
I am writing you on behalf of International Advocates for Spine Patients (IASP) as well as the patient population of North Carolina. IASP is an organization supported by physicians and patients dedicated to advocacy for high quality, widely accessible and cost effective spine care for patients around the world. I am on the Board of IASP (a sister organization to the International Society for the Advancement of Spine Surgery-ISASS) which was formed in 2011 to complement ISASS’ educational and scientific mission through direct advocacy efforts on the behalf of spine patients. I have spent the last 30 years in NC, generally working in healthcare or related fields. [...] I am writing to express serious concerns about numerous factual inaccuracies and omissions on the Blue Cross Blue Shield of North Carolina “Let’s Talk Cost” web site.
A new study published and presented by The International Society for the Advancement of Spine Surgery members Frank M. Phillips, MD, Paul J. Slosar, MD, Jim A. Youssef, MD, Gunnar Andersson, MD, PhD, and Frank Papatheofanis, MD, PhD, has concluded that fusion surgery is viable treatment option for reducing pain and improving function in patients with chronic lower back pain (LBP) refractory to nonsurgical care when a diagnosis of disc degeneration can be made. “Despite large number of publications of outcomes of spinal fusion surgery for chronic LBP, there is little consensus on efficacy,” says Dr. Phillips. “Our goal was to analyze and compile published evidence for lumbar fusion for selected patients with chronic LBP and DDD in order to provide an updated and comprehensive analysis of the clinical outcomes. We found clinically significant improvement in pain scores and functional levels after fusion in randomized studies as well as in prospective observational studies.”
December 20, 2012—Zimmer Spine, Inc. is initiating a voluntary worldwide recall of all 315 units of the PEEK Ardis® Inserter. The Ardis Inserter is a surgical instrument used during spinal surgery to implant the PEEK Ardis Interbody Spacer. The inserters are being recalled because Zimmer Spine has received reports of PEEK Ardis Interbody Spacer implant breakage when the implant is subjected to excessive lateral and/or off-axis forces from the inserter during surgery. Intra-operative complaint reports received to date indicate an occurrence rate of 0.52%. Observed health risks associated with implant fragments may include dural tears and blood loss. No post-operative complaints have been reported that are attributed to a fractured implant. Patients with concern about their implant should contact their healthcare provider.