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Spinal Interventional Pain Management and Lumbar Spine Surgery

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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). Services performed in connection with an emergency department visit or observation room confinement (POS 23) and services rendered during an inpatient stay (POS 21) do not require precertification. F. Precertification is not required for services ordered for FEP members. G. Codes that require precertification: Spinal Interventional Pain Management and Lumbar Spine Surgery 2 1. Spinal epidural injections: Cervical/Thoracic Region CPT Code Description 0228T Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level 0229T each additional level (List separately in addition to code for primary procedure) 62320 Injection(s), of diagnostic or therapeutic substance(s) (e.g. Anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging 62321 Injection(s), of diagnostic or therapeutic substance(s) (e.g. Anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging 64479 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, single level 64480 cervical or thoracic, each additional level (List separately in addition to code for primary procedure) Lumbar/Sacral Region CPT Code Description 0230T Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level 0231T each additional level (List separately in addition to code for primary procedure) 62322 Injection(s), of diagnostic or therapeutic substance(s) (e.g. Anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (cauda); without imaging 62323 Injection(s), of diagnostic or therapeutic substance(s) (e.g. Anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (cauda); with imaging 64483 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level 64484 lumbar or sacral, each additional level (List separately in addition to code for primary procedure) Spinal Interventional Pain Management and Lumbar Spine Surgery 3 2. Paravertebral facet joint denervation (radiofrequency neurolysis): Cervical/Thoracic region CPT Code Description 64633 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint 64634 cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure) Lumbar/Sacral region CPT Code Description 64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint 64636 lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure) 3. Paravertebral facet joint injections or blocks: Cervical/Thoracic region CPT Code Description 0213T Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, cervical or thoracic; single level 0214T second level (List separately in addition to code for primary procedure) 0215T third and any additional level(s) (List separately in addition to code for primary procedure) 64490 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level 64491 second level (List separately in addition to code for primary procedure) 64492 third and any additional level(s) (List separately in addition to code for primary procedure) Lumbar/Sacral region CPT Codes Description 0216T Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with ultrasound guidance, lumbar or sacral; single level 0217T second level (List separately in addition to code for primary procedure) 0218T third and any additional level(s) (List separately in addition to code for primary procedure) 64493 Injection(s), diagnostic or therapeutic agent, paravertebral facet Spinal Interventional Pain Management and Lumbar Spine Surgery 4 (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level 64494 second level (List separately in addition to code for primary procedure) 64495 third and any additional level(s) (List separately in addition to code for primary procedure) 4. Sacroiliac joint injections: CPT Codes Description 27096 Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed HCPCS Description Codes G0260 Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography (this code is to be billed by facilities only) 5. Lumbar spinal fusion surgery: Lumbar Fusion (single level) CPT Codes Description 22533 Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 22630 Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar 22633 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar ICD-10-PCS Codes Description 0SG0071, 0SG00A1, Fusion of lumbar vertebral joint, posterior approach, posterior 0SG00J1, 0SG00K1, column, open approach, code by device 0SG00Z1 0SG0371, 0SG03A1, Fusion of lumbar vertebral joint, posterior approach, posterior 0SG03J1, 0SG03K1, column, percutaneous approach, code by device Spinal Interventional Pain Management and Lumbar Spine Surgery 5 0SG03Z1 0SG0471, 0SG04A1, Fusion of lumbar vertebral joint, posterior approach, posterior 0SG04J1, 0SG04K1, column, percutaneous endoscopic approach, code by device 0SG04Z1 0SG1071, 0SG10A1, Fusion of lumbar vertebral joints, posterior approach, posterior 0SG10J1, 0SG10K1, column, open approach, code by device 0SG10Z1 0SG1371, 0SG13A1, Fusion of 2 or more lumbar vertebral joints, posterior approach, 0SG13J1, 0SG13K1, posterior column, percutaneous approach, code by device 0SG13Z1 0SG1471, 0SG14A1, Fusion of 2 or more lumbar vertebral joints, posterior approach, 0SG14J1, 0SG14K1, posterior column, percutaneous endoscopic approach, code by 0SG14Z1 device 0SG3071, 0SG30A1, Fusion of lumbosacral joint, posterior approach, posterior 0SG30J1, 0SG30K1, column, open approach, code by device 0SG30Z1 0SG3371, 0SG33A1, Fusion of lumbosacral joint, posterior approach, posterior 0SG33J1, 0SG33K1, column, percutaneous approach, code
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