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Spinal Interventional Pain Management and Spine Surgery

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Spinal Interventional Pain Management and Spine Surgery Spinal Interventional Pain Management and Spine Surgery Policy Number: Original Effective Date: MM.06.024 01/01/2014 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration; Medicare Advantage 11/01/2018 Section: Surgery; Medicine Place(s) of Service: Office; Outpatient; Inpatient I. Description The following spinal interventional pain management and 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 F. Artificial Intervertebral Disc Replacement: Cervical 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. This is a user-friendly website; most users find it self-explanatory and easy to use. Help is available. Click here to get started: (RadMD Get Started). 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 (cervical artificial intervertebral disc replacement, 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. Spinal Interventional Pain Management and Spine Surgery 2 G. Codes that require precertification: 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) (eg. 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) (eg. 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) (eg. 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) (eg. 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 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) Spinal Interventional Pain Management and Spine Surgery 4 64493 Injection(s), diagnostic or therapeutic agent, paravertebral facet (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. Artificial Intervertebral Disc Replacement: Cervical CPT Codes Description 22548 Arthrodesis, anterior transoral or extraoral technique, clivus-C1-C2 (atlas- axis), with or without excision of odontoid process 22551 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2 22552 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace (list separately in addition to code for separate procedure) 22554 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2 22585 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (list separately in addition to code for primary procedure) 22595 Arthrodesis, posterior technique, atlas-axis (C1-C2) 22590 Arthrodesis, posterior technique, craniocervical (occiput-C2) 22600 Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment Spinal Interventional Pain Management and Spine Surgery 5 22614 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (list separately in addition to code for primary procedure) 22856 Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection), single interspace, cervical 22858 Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); second level cervical 22861 Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical 22864 Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical
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