DOCSLIB.ORG

Cervical and Lumbar Spinal Procedures, MPM 25.1

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cervical and Lumbar Spinal Procedures, MPM 25.1 Medical Policy Subject: Cervical and Lumbar Spinal Procedures Medical Policy #: 25.1 Original Effective Date: 05/17/2010 Status: Reviewed Last Review Date: 05/26/2021 Disclaimer Refer to the member’s specific benefit plan and Schedule of Benefits to determine coverage. This may not be a benefit on all plans or the plan may have broader or more limited benefits than those listed in this Medical Policy. Coverage Determination Prior Authorization is required, Log on to the NIA Magellan website: www.RadMD.com to submit a “Request an Exam”. Presbyterian now uses NIA Magellan Lumbar Spinal Surgery. NIA prior authorizes or manage the provider precertification for Musculoskeletal Surgery Services, and not the facility precertification. Musculoskeletal Surgery Services rendered through the Emergency Room are not managed by NIA. All other inpatient and outpatient Musculoskeletal surgery procedures are managed by NIA for the surgeries outlined below. This Medical Policy includes information on the following items (Ctrl+Click to select): Lumbar Spine Surgery Lumbar Spine Surgery Description Indication Exclusion Coding Lumbar Spinal Fusion (single level) Surgery Lumbar Spinal Fusion (multiple levels) Surgery Lumbar Decompression Procedures Lumbar Discectomy/Microdiscectomy procedure Cervical Spine Surgery Cervical Description Indications Coding Anterior Cervical Decompression with Fusion (ACDF) Single level Anterior Cervical Decompression with Fusion (ACDF) – Multiple level: Cervical Posterior Decompression with Fusion – Single Leve Cervical Posterior Decompression with Fusion- Multiple Levels: Cervical Artificial Disc – Single Level: Cervical Artificial Disc – Two Levels: Cervical Posterior Decompression (without fusion): Cervical Anterior Decompression (without fusion): LUMBAR SPINAL SURGERY Not every Presbyterian health plan contains the same benefits. Please refer to the member’s specific benefit plan and Schedule of Benefits to determine coverage [MPMPPC051001]. 1 Lumbar Lumbar Spinal Fusion Surgery Spine Surgery Lumbar Decompression Procedures Lumbar Microdiscectomy Only Procedures Description This guideline outlines the key surgical treatments and indications for common lumbar spinal disorders and is a consensus document based upon the best available evidence. Spine surgery is a complex area of medicine and this document breaks out the treatment modalities for lumbar spine disorders into surgical categories: lumbar discectomy/microdiscectomy, lumbar decompression, and lumbar fusion surgery. Artificial disc replacement is an alternative to spinal fusion for the treatment of symptomatic disc disease. These devices are designed to maintain the function of the natural spine by preserving motion, and to potentially limit the incidence of adjacent segment degeneration. Presbyterian Health Plan covers cervical artificial disc replacement, but does not cover lumbar artificial disc replacement Indication INDICATIONS FOR LUMBAR SURGERY: (This section of the clinical guidelines can be found on the NIA Magellan Clinical website, which thoroughly provides the clinical criteria for each of the lumbar and pre-sacral spine surgery categories.) I. Indications for Lumbar Discectomy/Microdiscectomy: Surgical indications for intervertebral disc herniation: II. Indications for Lumbar Decompression: Laminectomy, Laminotomy, Facetectomy, and Foraminotomy. These procedures allow decompression by partial or total removal of various parts of vertebral bone and ligaments. Surgical Indications for spinal canal decompression due to lumbar spinal stenosis: III. Indications for Lumbar Spine Fusion: IV. CONTRAINDICATIONS FOR SPINE SURGERY (Note:Cases will not be approved if the below contraindications exist): 1. Medical contraindications 2. Psychosocial risk factors. 3. Active Tobacco or Nicotine 4. Morbid Obesity V. Other ADDITIONAL INFORMATION Exclusion Services not covered: The following procedures are not covered as they are either still under investigation or are not recommended based upon the current evidence: • Percutaneous Lumbar Discectomy • Laser Discectomy • Percutaneous Radiofrequency Disc Decompression • Intradiscal Electrothermal Annuloplasty (IDEA or IDET) • Nucleus Pulpous Replacement • Pre-Sacral Fusion, or • Lumbar Artificial Disc Replacement CODING The coding listed in this medical policy is for reference only. Covered and non-covered codes are within this list. CPT Code Lumbar Spinal Fusion (single level) Surgery Arthrodesis, lateral extracavitary technique, including minimal discectomy to 22533 prepare interspace; lumbar Arthrodesis, anterior interbody technique, including minimal discectomy to 22558 prepare interspace; (other than for decompression); lumbar Arthrodesis, posterior or posterolateral technique, single level; lumbar (with 22612 lateral transverse technique, when performed) Arthrodesis, posterior interbody technique, including laminectomy and/or 22630 discectomy to prepare interspace, single interspace; lumbar Not every Presbyterian health plan contains the same benefits. Please refer to the member’s specific benefit plan and Schedule of Benefits to determine coverage [MPMPPC051001]. 2 CPT Code Lumbar Spinal Fusion (single level) Surgery Arthrodesis, combined posterior or posterolateral technique with posterior 22633 interbody technique including laminectomy and/or discectomy sufficient to prepare interspace, single interspace and segment; lumbar For CPT codes listed above include also Decompression (see below for codes) CPT Code Lumbar Spinal Fusion (multiple levels) Surgery Arthrodesis, lateral extracavitary technique, including minimal discectomy to 22533 prepare interspace; lumbar Arthrodesis, lateral extracavitary technique, including minimal discectomy to +22534 prepare interspace; thoracic or lumbar, each additional vertebral segment Arthrodesis, anterior interbody technique, including minimal discectomy to 22558 prepare interspace; lumbar Arthrodesis, anterior interbody technique, including minimal discectomy to +22585 prepare interspace; each additional interspace. (List separately in addition to code for primary procedure) Code first (22554-22558) 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar Arthrodesis, posterior or posterolateral technique, single level; each additional +22614 vertebral segment. (List separately in addition to code for primary procedure) Code first (22612, 22630,22633) Arthrodesis, posterior interbody technique, including laminectomy and/or 22630 discectomy to prepare interspace, single interspace; lumbar Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace, single interspace; each additional +22632 interspace. (List separately in addition to code for primary procedure). Code first (22612, 22630, 22633) Arthrodesis, combined posterior or posterolateral technique with posterior 22633 interbody technique including laminectomy and/or discectomy sufficient to prepare interspace, single interspace and segment; lumbar Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to +22634 prepare interspace, single interspace and segment; each additional interspace and segment. (List separately in addition to code for primary procedure). Code first (22633) For CPT codes listed above include also Decompression (see below for codes) CPT Code Lumbar Decompression Procedures Laminectomy with exploration and/or decompression of spinal cord and/or 63005 cauda equina, without facetectomy, foraminotomy or discectomy (e.g., spinal stenosis), 1 or 2 vertebral segments; lumbar, except for spondylolisthesis. Laminectomy with removal of abnormal facets and/or pars inter-articularis with 63012 decompression of cauda equina and nerve roots for spondylolisthesis, lumbar (Gill type procedure) Laminectomy with exploration and/or decompression of spinal cord and/or 63017 cauda equina, without facetectomy, foraminotomy or discectomy, more than 2 vertebral segments; lumbar Laminotomy, with decompression of nerve root(s), including partial 63030 facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar Laminotomy, with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; +63035 each additional interspace, cervical or lumbar. (List separately in addition to code for primary procedure). Code first (63020-63030) Not every Presbyterian health plan contains the same benefits. Please refer to the member’s specific benefit plan and Schedule of Benefits to determine coverage [MPMPPC051001]. 3 CPT Code Lumbar Decompression Procedures Laminotomy, (hemilaminectomy) with decompression of nerve root(s), 63042 including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar Laminotomy, (hemilaminectomy) with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated +63044 intervertebral disc, reexploration, single interspace; each additional lumbar interspace. (List separately in addition to code for primary procedure). First code (63042) Laminectomy, facetectomy and foraminotomy, (unilateral or bilateral with 63047 decompression of spinal cord, cauda equine and/or nerve root[s]. [e.g., spinal or lateral recess stenosis]), (single vertebral segment; lumbar Laminectomy, facetectomy and foraminotomy, (unilateral or bilateral with decompression
Load more

Recommended publications
  • Modified Plate-Only Open-Door Laminoplasty Versus Laminectomy and Fusion for the Treatment of Cervical Stenotic Myelopathy
    n Feature Article Modified Plate-only Open-door Laminoplasty Versus Laminectomy and Fusion for the Treatment of Cervical Stenotic Myelopathy LILI YANG, MD; YIFEI GU, MD; JUEQIAN SHI, MD; RUI GAO, MD; YANG LIU, MD; JUN LI, MD; WEN YUAN, MD, PHD abstract Full article available online at Healio.com/Orthopedics. Search: 20121217-23 The purpose of this study was to compare modified plate-only laminoplasty and lami- nectomy and fusion to confirm which of the 2 surgical modalities could achieve a better decompression outcome and whether a significant difference was found in postopera- tive complications. Clinical data were retrospectively reviewed for 141 patients with cervical stenotic myelopathy who underwent plate-only laminoplasty and laminectomy and fusion between November 2007 and June 2010. The extent of decompression was assessed by measuring the cross-sectional area of the dural sac and the distance of spinal cord drift at the 3 most narrowed levels on T2-weighted magnetic resonance imaging. Clinical outcomes and complications were also recorded and compared. Significant en- largement of the dural sac area and spinal cord drift was achieved and well maintained in both groups, but the extent of decompression was greater in patients who underwent Figure: T2-weighted magnetic resonance image laminectomy and fusion; however, a greater decompression did not seem to produce a showing the extent of decompression assessed by better clinical outcome. No significant difference was observed in Japanese Orthopaedic measuring the cross-sectional area of the dural sac Association and Nurick scores between the 2 groups. Patients who underwent plate-only (arrow). laminoplasty showed a better improvement in Neck Dysfunction Index and visual ana- log scale scores.
    [Show full text]
  • Subchondral Bone Regenerative Effect of Two Different Biomaterials in the Same Patient
    Hindawi Publishing Corporation Case Reports in Orthopedics Volume 2013, Article ID 850502, 5 pages http://dx.doi.org/10.1155/2013/850502 Case Report Subchondral Bone Regenerative Effect of Two Different Biomaterials in the Same Patient Marco Cavallo,1 Roberto Buda,2 Francesca Vannini,1 Francesco Castagnini,1 Alberto Ruffilli,1 and Sandro Giannini2 1 IClinic,RizzoliOrthopaedicInstitute,BolognaUniversity,ViaGiulioCesarePupilli1,40136Bologna,Italy 2 Orthopaedics and Traumatology, I Clinic, Rizzoli Orthopaedic Institute, Bologna University, Via Giulio Cesare Pupilli 1, 40136Bologna,Italy Correspondence should be addressed to Marco Cavallo; [email protected] Received 2 May 2013; Accepted 17 June 2013 Academic Editors: E. R. Ahlmann, M. Cadossi, and A. Sakamoto Copyright © 2013 Marco Cavallo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This case report aims at highlighting the different effects on subchondral bone regeneration of two different biomaterials inthe same patient, in addition to bone marrow derived cell transplantation (BMDCT) in ankle. A 15-year-old boy underwent a first BMDCT on a hyaluronate membrane to treat a deep osteochondral lesion (8 mm). The procedure failed: subchondral bone was still present at MRI. Two years after the first operation, the same procedure was performed on a collagen membrane with DBM filling the defect. After one year, AOFAS score was 100 points, and MRI showed a complete filling of the defect. The T2 mapping MRI after one year showed chondral tissue with values in the range of hyaline cartilage.
    [Show full text]
  • 2019 Spine Coding Basics
    2019 Spine Coding Basics Presenter: Kerri Larson, CPC Directory of Coding and Audit Services 2019 Spine Surgery 01 Spine Surgery Terminology & Anatomy 02 Spine Procedures 03 Case Study 04 Diagnosis 05 Q & A Spine Surgery Terminology & Anatomy Spine Surgery Terminology & Anatomy Term Definition Arthrodesis Fusion, or permanent joining, of a joint, or point of union of two musculoskeletal structures, such as two bones Surgical procedure that replaces missing bone with material from the patient's own body, or from an artificial, synthetic, or Bone grafting natural substitute Corpectomy Surgical excision of the main body of a vertebra, one of the interlocking bones of the back. Cerebrospinal The protective body fluid present in the dura, the membrane covering the brain and spinal cord fluid or CSF Decompression A procedure to remove pressure on a structure. Diskectomy, Surgical removal of all or a part of an intervertebral disc. discectomy Dura Outermost of the three layers that surround the brain and spinal cord. Electrode array Device that contains multiple plates or electrodes. Electronic pulse A device that produces low voltage electrical pulses, with a regular or intermittent waveform, that creates a mild tingling or generator or massaging sensation that stimulates the nerve pathways neurostimulator Spine Surgery Terminology & Anatomy Term Definition The space that surrounds the dura, which is the outermost layer of membrane that surrounds the spinal canal. The epidural space houses the Epidural space spinal nerve roots, blood and lymphatic vessels, and fatty tissues . Present inside the skull but outside the dura mater, which is the thick, outermost membrane covering the brain or within the spine but outside Extradural the dural sac enclosing the spinal cord, nerve roots and spinal fluid.
    [Show full text]
  • Analysis of the Cervical Spine Alignment Following Laminoplasty and Laminectomy
    Spinal Cord (1999) 37, 20± 24 ã 1999 International Medical Society of Paraplegia All rights reserved 1362 ± 4393/99 $12.00 http://www.stockton-press.co.uk/sc Analysis of the cervical spine alignment following laminoplasty and laminectomy Shunji Matsunaga1, Takashi Sakou1 and Kenji Nakanisi2 1Department of Orthopaedic Surgery, Faculty of Medicine, Kagoshima University; 2Department of Mechanical Engineering, Faculty of Engineering, Kagoshima University, Sakuragaoka, Kagoshima, Japan Very little detailed biomechanical examination of the alignment of the cervical spine following laminoplasty has been reported. We performed a comparative study regarding the buckling- type alignment that follows laminoplasty and laminectomy to know the mechanical changes in the alignment of the cervical spine. Lateral images of plain roentgenograms of the cervical spine were put into a computer and examined using a program we developed for analysis of the buckling-type alignment. Sixty-four patients who underwent laminoplasty and 37 patients who underwent laminectomy were reviewed retrospectively. The subjects comprised patients with cervical spondylotic myelopathy (CSM) and those with ossi®cation of the posterior longitudinal ligament (OPLL). The postoperative observation period was 6 years and 7 months on average after laminectomy, and 5 years and 6 months on average following laminoplasty. Development of the buckling-type alignment was found in 33% of patients following laminectomy and only 6% after laminoplasty. Development of buckling-type alignment following laminoplasty appeared markedly less than following laminectomy in both CSM and OPLL patients. These results favor laminoplasty over laminectomy from the aspect of mechanics. Keywords: laminoplasty; laminectomy; buckling; kyphosis; swan-neck deformity Introduction In 1930, Eiselberg1 reported a case of postoperative of postoperative abnormal alignment from the aspect kyphosis of the spine following laminectomy from the of the presence or absence of buckling-type alignment.
    [Show full text]
  • Spinal Interventional Pain Management and Lumbar Spine Surgery
    Spinal Interventional Pain Management and Lumbar Spine Surgery Policy Number: Original Effective Date: MM.06.024 01/01/2014 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 12/15/2017 Section: Surgery; Medicine Place(s) of Service: Office; Outpatient; Inpatient I. Description The following spinal interventional pain management and lumbar spine surgery procedures require precertification through Magellan Hawaii, formally known as National Imaging Associates, Inc. (NIA): A. Spinal Epidural Injections B. Paravertebral Facet Joint Denervation (radiofrequency neurolysis) C. Paravertebral Facet Joint Injections or Blocks D. Sacroiliac joint injections E. Lumbar Spinal Fusion Surgery II. Administrative Guidelines A. The ordering physician can obtain precertification or consult with Magellan Hawaii by accessing their website at http://www.radmd.com/ or by calling 1 (866) 306-9729, from 6 a.m. to 6 p.m., weekdays, Hawaii Time. Refer to the e-library for instructions on navigating the radmd.com website (RadMD Get Started) and requesting precertification/checking the status of a request (RadMD QuickStart). B. For access to the latest clinical guidelines used for precertification, go to www.radmd.com and click on the link entitled View Clinical Guidelines. C. For interventional pain management procedures (epidural injections, facet joint denervation neurolysis, facet joint injections and sacroiliac joint injections), if more than one procedure is planned, a separate precertification number must be obtained for each procedure planned. D. For spinal surgeries (lumbar fusions, lumbar decompressions, and lumbar microdiscectomy), one precertification number should be obtained for the most invasive surgery to be performed. E. Precertification requirements for injection procedures apply only to office and outpatient services (POS 11, 22, or 24).
    [Show full text]
  • Lumbar Laminectomy
    Patient Education Lumbar Laminectomy Description The spine consists of five separate divisions: cervical (seven vertebrae), thoracic (12 vertebrae), lumbar (five vertebrae), the sacrum, and the coccyx. Each vertebra, interlocks with the segment above and below it through the superior and inferior articular processes. Between each vertebra is an intervertebral disc that provides cushioning for the spine. The lamina and pedicle, along with the vertebral body, provide the borders that create the spinal canal, which the spinal cord runs through to transmit nerve signals. There are several different scenarios or conditions that may produce symptoms that would lead your physician to further Medical Illustration © 2016 Nucleus Medical Art, Inc. investigate, and possibly recommend this surgery. Stenosis causing Radicular Pain Spinal stenosis is the narrowing of the articular spaces within the spine; this may impinge on the nerves or the spinal cord. This is a degenerative process and may eventually lead to further changes on the spine over time. Radicular symptoms are pain, numbness, weakness, tingling, etc., that radiate along a specific nerve root (or dermatome) to other parts of the body outside of the spine. Surgical correction of this problem may include a minimally invasive decompression (shaving bone away to create more space around the nerve), often referred to as laminectomy (removing part or all of the lamina in order to provide more space and relieve impingement). In some cases, movement of one vertebrae slipping against another (spondylolisthesis), may require a vertebral fusion. This may be performed open vs. minimally invasive. Disc Herniation Herniation of the intervertebral disc may be due to an acute traumatic incident.
    [Show full text]
  • Subtalar Joint Version 1.0 Effective June 15, 2021
    CLINICAL GUIDELINES CMM-407: Arthroscopy: Subtalar Joint Version 1.0 Effective June 15, 2021 Clinical guidelines for medical necessity review of Comprehensive Musculoskeletal Management Services. © 2021 eviCore healthcare. All rights reserved. Comprehensive Musculoskeletal Management Guidelines V1.0 CMM-407: Arthroscopy: Subtalar Joint Definitions 3 General Guidelines 3 Indications 4 Non-Indications 5 Procedure (CPT®) Codes 5 References 6 ______________________________________________________________________________________________________ ©2021 eviCore healthcare. All Rights Reserved. Page 2 of 6 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www.eviCore.com Comprehensive Musculoskeletal Management Guidelines V1.0 Definitions Red flags indicate comorbidities that require urgent/emergent diagnostic imaging and/or referral for definitive therapy. Clinically meaningful improvement is defined as at least 50% improvement noted on global assessment. General Guidelines Either of the following are considered red flag conditions for subtalar joint arthroscopy: Post-reduction evaluation and management of the subtalar dislocation Septic arthritis in the subtalar joint Although imaging may be normal, prior to subtalar joint arthroscopy, radiographic imaging should be performed and include both of the following: Plain X-rays with one or more views (anteroposterior, lateral, axial, and/or Broden’s) to confirm and differentiate any of the following: Degenerative joint changes Loose bodies Osteochondral lesions Impingement
    [Show full text]
  • Lumbar Laminectomy Or Laminotomy
    Patient Instructions: Lumbar Laminectomy or Laminotomy Surgical Technique A lumbar laminectomy or laminotomy is a surgical approach performed from the back of the lumbar spine. It is usually done through an incision in the middle of the back. Using minimally invasive techniques a small window of bone is drilled in the lamina to allow the surgeon to unpinch the underlying nerves (laminotomy), or in more severe cases the bone is removed completely on both sides to allow nerves on both sides of the spinal canal to be decompressed (laminectomy). It is done using an operating microscope and microsurgical technique. It is used to treat spinal stenosis or lateral recess stenosis and alleviate the pain and/or numbness that occurs in a patients lower back or legs. It can many times be performed on an outpatient basis without the need for an overnight stay in a hospital. Before Surgery • Seven days prior to surgery, please do not take any anti-inflammatory NSAID medications (Celebrex, Ibuprofen, Aleve, Naprosyn, Advil, etc.) as this could prolong your bleeding time during surgery. • Do not eat or drink anything after midnight the day before surgery. This means nothing to drink the morning of surgery except you may take your normal medication with a sip of water if needed. This includes your blood pressure medicine, which in general should be taken. Consult your surgeon or primary care doctor regarding insulin if you take it. • Please do not be late to check in on the day of surgery or it may be cancelled. • Please bring your preoperative folder with you to the surgery and have it when you check in.
    [Show full text]
  • In Patients with End-Stage Ankle Arthritis, How Does Total Ankle Arthroplasty Compared to Arthrodesis Affect Ankle Pain and Function?
    University of the Pacific Scholarly Commons Physician's Assistant Program Capstones School of Health Sciences 4-1-2020 In Patients with End-Stage Ankle Arthritis, How Does Total Ankle Arthroplasty Compared to Arthrodesis Affect Ankle Pain and Function? Zachary Whipple University of the Pacific, [email protected] Follow this and additional works at: https://scholarlycommons.pacific.edu/pa-capstones Part of the Medicine and Health Sciences Commons Recommended Citation Whipple, Zachary, "In Patients with End-Stage Ankle Arthritis, How Does Total Ankle Arthroplasty Compared to Arthrodesis Affect Ankle Pain and Function?" (2020). Physician's Assistant Program Capstones. 84. https://scholarlycommons.pacific.edu/pa-capstones/84 This Capstone is brought to you for free and open access by the School of Health Sciences at Scholarly Commons. It has been accepted for inclusion in Physician's Assistant Program Capstones by an authorized administrator of Scholarly Commons. For more information, please contact [email protected]. In Patients with End-Stage Ankle Arthritis, How Does Total Ankle Arthroplasty Compared to Arthrodesis Affect Ankle Pain and Function? By Zachary Whipple Capstone Project Submitted to the Faculty of the Department of Physician Assistant Education of the University of the Pacific in partial fulfilment of the requirements for the degree of MASTER OF PHYSICIAN ASSISTANT STUDIES April 2020 Introduction End-stage ankle arthritis is a debilitating degenerative disease commonly located at the tibiotalar joint. The prevalence of symptomatic arthritis is about nine times lower than the rates associated with those of the knee or hip.1 Though less common than knee and hip arthritis, the US estimates greater than 50,000 new cases are reported each year.2 The most common etiology of ankle arthritis is post-traumatic pathology.
    [Show full text]
  • Pain Management & Spine Surgery Procedures
    OrthoNet PPA Code List Pain Management and Spine Surgery Procedures AND Effective 01/01/2018 Major Joint and Foot/ Lower Extremity Procedures (Blue Medicare HMO PPO) CATEGORY PROCCODE PROCEDURE DESCRIPTION Pain Management & Spine Surgery Procedures Spinal Fusion 22510 Perq cervicothoracic inject Spinal Fusion 22511 Perq lumbosacral injection Spinal Fusion 22512 Vertebroplasty addl inject Spinal Fusion 22513 Perq vertebral augmentation Spinal Fusion 22514 Perq vertebral augmentation Spinal Fusion 22515 Perq vertebral augmentation Spinal Fusion 22532 LAT THORAX SPINE FUSION Spinal Fusion 22533 LAT LUMBAR SPINE FUSION Spinal Fusion 22534 LAT THOR/LUMB ADDL SEG Spinal Fusion 22548 NECK SPINE FUSION Spinal Fusion 22551 NECK SPINE FUSE&REMOV BEL C2 Spinal Fusion 22552 ADDL NECK SPINE FUSION Spinal Fusion 22554 NECK SPINE FUSION Spinal Fusion 22556 THORAX SPINE FUSION Spinal Fusion 22558 LUMBAR SPINE FUSION Spinal Fusion 22585 ADDITIONAL SPINAL FUSION Spinal Fusion 22590 SPINE & SKULL SPINAL FUSION Spinal Fusion 22595 NECK SPINAL FUSION Spinal Fusion 22600 NECK SPINE FUSION Spinal Fusion 22610 THORAX SPINE FUSION Spinal Fusion 22612 LUMBAR SPINE FUSION Spinal Fusion 22614 SPINE FUSION, EXTRA SEGMENT Spinal Fusion 22630 LUMBAR SPINE FUSION Spinal Fusion 22632 SPINE FUSION, EXTRA SEGMENT Spinal Fusion 22633 LUMBAR SPINE FUSION COMBINED Spinal Fusion 22634 SPINE FUSION EXTRA SEGMENT Spinal Fusion 22800 FUSION OF SPINE Spinal Fusion 22802 FUSION OF SPINE Spinal Fusion 22804 FUSION OF SPINE Spinal Fusion 22808 FUSION OF SPINE Spinal Fusion 22810 FUSION
    [Show full text]
  • Hounsfield Units on Lumbar Computed Tomography For
    Open Med. 2019; 14: 545-551 Research Article Kyung Joon Kim, Dong Hwan Kim, Jae Il Lee, Byung Kwan Choi, In Ho Han, Kyoung Hyup Nam* Hounsfield Units on Lumbar Computed Tomography for Predicting Regional Bone Mineral Density https://doi.org/10.1515/med-2019-0061 Keywords: Hounsfield Unit; Bone Mineral Density (BMD); received March 28, 2019; accepted June 7, 2019 Dual X-ray absorptiometry (DEXA); Quantitative com- puted tomography (QCT); Osteoporosis Abstract: Objective: Bone mineral density (BMD) is a very important factor in spinal fusion surgery using instrumen- tation. Our aim was to investigate the utility of Hounsfield units (HU) obtained from preoperative lumbar computed tomography (CT) to predict osteoporosis coupling with data of quantitative computed tomography (QCT) and 1 Introduction dual X-ray absorptiometry (DEXA). Bone quality is an important prognostic factor for spinal Methods. We reviewed 180 patients that underwent both fusion with instrumentation. Severe osteoporosis is a sig- QCT and lumbar CT for spine surgery. HU was retrospec- nificant cause of hardware failure such as pedicle screw tively calculated on the lumbar CT of 503 lumbar vertebrae loosening and pull-out after spinal fusion surgery. Thus, from L1 to L3. Femur DEXA was performed in all patients bone mineral density (BMD) is a very important factor in and spine DEXA was tested in 120 patients (331 vertebrae). spinal fusion surgery, and the diagnosis of osteoporosis BMD was grouped as osteoporosis (QCT<80mg/cm3, DEXA before surgery is very important. BMD using dual X-ray T score≤-2.5) and non-osteoporosis (QCT≥80mg/cm3, absorptiometry (DEXA) or quantitative computed tomog- DEXA T score>-2.5) for comparison of HU value.
    [Show full text]
  • Musculoskeletal Program CPT Codes and Descriptions
    Musculoskeletal Program CPT Codes and Descriptions Spine Surgery Procedure Codes CPT CODES DESCRIPTION Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition 20930 to code for primary procedure) 20931 Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure) Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar 20936 fragments) obtained from same incision (List separately in addition to code for primary procedure) Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial 20937 incision) (List separately in addition to code for primary procedure) Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate 20938 skin or fascial incision) (List separately in addition to code for primary procedure) 20974 Electrical stimulation to aid bone healing; noninvasive (nonoperative) Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral 22206 body subtraction); thoracic Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral 22207 body subtraction); lumbar Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral 22208 body subtraction); each additional vertebral segment (List separately in addition to code for
    [Show full text]