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Bronchial Thermoplasty for Severe Asthma

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Bronchial Thermoplasty for Severe Asthma Health Evidence Review Commission’s Value-based Benefits Subcommittee December 13, 2012 Meridian Park Hospital Community Health Education Center, Room 117B&C 19300 SW 65th Avenue, Tualatin, OR 97062 Section 1 Agenda AGENDA VALUE-BASED BENEFITS SUBCOMMITTEE December 13, 2012 8:30am - 2:30pm Meridian Park Room 117B&C Community Health Education Center Tualatin, OR 97062 A working lunch will be served at approximately 12:00 PM All times are approximate I. Call to Order, Roll Call, Approval of Minutes – Lisa Dodson 8:30 AM II. Staff report – Ariel Smits, Cat Livingston, Darren Coffman 8:35 AM III. Straightforward 8:45 AM A. Straightforward issues table B. Low back pain coding specifications C. Bariatric surgery coding specification IV. New CPT Codes 8:50 AM A. 2013 CPT codes A. 2013 Genetic testing CPT codes B. 2013 Psychiatric CPT codes B. 2013 HCPCS codes C. 2013 CDT codes A. Dental guideline changes V. New discussion items 11:00 AM A. Silver nitrate treatments for dental caries B. Pseudobulbar affect VI. Coverage Guidances for review 12:00 PM A. Viscosupplementation for osteoarthritis of the knee B. Percutaneous interventions for low back pain C. Management of chronic otitis media in children VII. Previous Discussion Items 1:00 PM A. Puberty suppression for transgendered youth VIII. Guidelines 1:45 PM A. Guideline note 44, Menstrual Bleeding Disorders B. Prenatal genetic testing guideline IX. Public comment 2:25 PM X. Adjournment 2:30 PM Section 2 Minutes Value-based Benefits Subcommittee Recommendations Summary For Presentation to: Health Evidence Review Commission on October 11, 2012 For specific coding recommendations and guideline wording, please see the text of the (10/11/12) VbBS minutes. CODE MOVEMENT • Spinal arthrodesis codes were added to lines that had some, but not all, of the spinal arthrodesis codes • Acupuncture and cognitive behavioral therapy were added to the low back pain lines • Spinal traction was removed from the low back pain lines • Artificial disc replacement was added to the covered and the uncovered spinal conditions lines • Electromyelography was recommended to be moved from the Ancillary to the Diagnostic List • Transcranial magnetic stimulation was added to the major depression line • A series of straightforward code changes were accepted • Injections into the labyrinth were added for treatment of Meniere’s disease • Several procedures were added for the treatment of congenital dislocation of the hip ITEMS CONSIDERED BUT NO CHANGES MADE • An unspecific ICD-9 code for toe walking was considered for movement from an uncovered line to a covered dysfunction line; however, a more specific code for tendon contractures was found to pair with the desired treatment and was felt to represent more appropriate coding • A guideline for neuroimaging in headache was considered, but will be revisited in December GUIDELINE CHANGES A series of guidelines were revised to ensure consistency between the Prioritized List and HERC-approved coverage guidances • DIAGNOSTIC GUIDELINE D4, ADVANCED IMAGING FOR LOW BACK PAIN was changed to include the imaging recommendation table included in the HERC low back pain evidence-based guideline • GUIDELINE NOTE 85, ELECTIVE INDUCTION OF LABOR. The Guideline Note was clarified to indicate that elective induction of labor is not covered for elective induction of labor prior to 41 weeks except in the cases of maternal diabetes, prelabor rupture of membranes, or other medical or obstetrical indications. Other guideline notes were revised: • GUIDELINE NOTE 7, ERYTHROPOIESIS-STIMULATING AGENT (ESA) GUIDELINE. The Guideline Note was changed to require reassessment of ESA use at 12 rather than 8 weeks of therapy for patients with renal insufficiency. Value-based Benefits Subcommittee Summary Recommendations, 10/11//12 • GUIDELINE NOTE 37 DISORDERS OF SPINE WITH NEUROLOGIC IMPAIRMENT was modified to clarify the definition of radiculopathy and which lines contained which diagnoses • GUIDELINE NOTE 47, URINARY INCONTINENCE. The Guideline Note was modified to not include electrical stimulation as a possible modality that could be required to be tried prior to surgery. • GUIDELINE NOTE 92, ACUPUNCTURE was revised to allow coverage for low back pain for 12 visits and for tension headache New guidelines were adopted: • GUIDELINE NOTE XXX, SMOKING AND SPINAL FUSION. This guideline allows coverage of spinal fusion only for non-smoking patients. • GUIDELINE NOTE XXX, FOREIGN BODIES IN THE GI TRACT was adopted to specify that hazardous foreign bodies would be covered on a higher line, nonhazardous bodies on a lower line A series of new guidelines were adopted to ensure consistency between the Prioritized List and HERC-approved coverage guidances • GUIDELINE NOTE XXX, ARTIFICIAL DISC REPLACEMENT was adopted which details when artificial disc replacement would potentially be covered. • GUIDELINE NOTE XXX, NON-PHARMACOLOGIC INTERVENTIONS FOR TREATMENT-RESISTANT DEPRESSION was adopted to require trials of two antidepressant medications prior to ECT or repetitive transcranial magnetic stimulation • DIAGNOSTIC GUILDELINE XXX, NEUROIMAGING IN DEMENTIA was adopted specifying when neuroimaging is covered for the work up of dementia CHANGES FOR THE OCTOBER 1, 2014 (TENTATIVE) PRIORITIZED LIST AS PART OF THE ICD-10 CONVERSION PROCESS . Various ICD-10 codes for peripheral neuropathies were moved from an uncovered sprain/strain line to covered nerve disorder lines . Foreign body codes were added to a covered line with a guideline specifying when these codes are on the upper covered and when on the lowered uncovered lines . Albinism codes were added to the precancerous skin condition line; certain albinism codes involving conditions of the eyes were also added to an ophthalmology line VALUE-BASED BENEFITS SUBCOMMITTEE Meridian Park Health Education Center October 11, 2012 8:30 AM – 1:30 PM Members Present: Lisa Dodson, MD, Chair; Kevin Olson, MD, Vice-chair; Chris Kirk, MD; James Tyack, DMD; Mark Gibson; Laura Ocker, Lac; David Pollack, MD; Irene Croswell, RPh (by phone) Members Absent: None Staff Present: Darren Coffman; Ariel Smits, MD, MPH; Cat Livingston, MD, MPH; Jason Gingerich; Dorothy Allen Also Attending: Denise Taray (DMAP); Kathy Kirk, Oregon Pain Management Commission Roll Call/Minutes Approval/Staff Report The meeting was called to order at 8:30 am and roll was called. Minutes from the August 9, 2012 VbBS meeting were reviewed and approved as submitted. ACTION: HERC staff will post the approved minutes on the website as soon as possible. An orthopedic surgeon from Roseburg has expressed interest in joining the VbBS/HERC. The HERC has been looking for surgical expertise in a member. The subcommittee had no objections to having the HERC consider her for VbBS membership. She will likely be joining the VbBS for the December meeting. Coffman discussed having a possible new timeline for dealing with new CPT codes. These codes are expected to be published in September rather than late October. The VbBS may take these codes up in November (starting in 2013) and publish a new List on January 1st to allow the new codes to be incorporated into the List in a timely fashion. The downside of this proposal would be to have a longer time between Lists (January 1 and October 1 rather than April 1 and October 1). Kirk reported that the plans did not have an issue with the delayed code publication to date. HERC staff will continue to examine this possible change and update the subcommittee. Smits presented a HERC staff request for input from the subcommittee for dealing with treatments with low effectiveness and high cost. Two options would be a specific guideline for each new class of treatment or a general guideline outlining general coverage guidance. Gibson thought that a set of principles for coverage would be useful. Ocker suggested that some of these treatments should still be brought to the committee to review. Coffman mentioned that previous discussions with the HSC had brought up issues about having an absolute number (QALY threshold) in a guideline. Kirk urged staff to consider the guideline note method as these notes have been very useful for the plans and in the legal process. Topic: Mononeuritis and other peripheral neuropathies Value-based Benefits Subcommittee Minutes, 10/11/12 Page 3 Discussion: Livingston introduced a summary document with suggested placement changes for ICD-10 codes for peripheral neuropathies on the 2014 list. It was clarified the new acute peripheral nerve injury line included surgical treatment only. There was minimal discussion and changes were approved as proposed. Actions: 1) G57.10-G57.13 moved from line 638 to lines 535 and 557 2) G57.20-G57.22 moved from line 638 to lines 450 (new line on October 1, 2014 List), 535 and 557. 3) G57.40-G57.42 moved from line 557 to line 441 4) G58.8-G58.9 moved from line 638 to lines 535 and 557 5) DMAP advised to move G59 from line 638 to the Excluded File Topic: Toe walking Discussion: Smits introduced a summary regarding coverage of toe walking. Kirk brought up that most toe-walking self resolves and therefore does not need to be covered. Pollack was concerned about the cases in which kids have an underlying medical condition which results in the toe walking, such as cerebal palsy. In CP and other cases, there are true ligament contractures. The group felt that ligament contractures should be covered, but not toe walking per se. Smits noted that 727.18 (ligament contracture) was on line 318 and paired with the tendon lengthening CPT code requested for treatment of toe walking. The decision was that 727.18 could be used to code for this condition when surgery is required. Providers may need to be educated that this pairing exists on line 318. Toe walking (ICD-9 739.79) was not added to line 318. Actions: No changes made to the Prioritized List Topic: Erythropoeisis stimulating guideline revision Discussion: Livingston introduced a summary document regarding suggested changes to the erythropoeisis stimulating agents (ESAs) guideline.
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