Musculoskeletal Program CPT Codes and Descriptions
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Volume 15, Issue 1, January-April
Volume 15, Issue 1, January-April Osteochondral lesions of the talus in adults J. Batista, G. Joannas, L. Casola, L. Logioco, G. Arrondo 1A Traumatic lesion with isolated cartilage injury (flap) Tx: arthroscopy, curettage, and microfractures. 1B Traumatic lesion (cartilage and subchondral bone injury) 1B.1 Lesion <10mm in diameter and <5mm of depth (superficial lesion) Tx: arthroscopy, curettage, and microfractures. 1B.2 Lesion >10mm in diameter and >5mm in depth Tx: fragment fixation with osteosynthesis, open surgery, osteochondral graft, or mosaicoplasty. 2A Non-traumatic isolated bone injury, subchondral cyst. Tx: retrograde drilling. 2B Non-traumatic open subchondral bone cyst with articular connection (progression of type 2A). 2B.1 Lesion measuring <10mm in diameter and <5mm in depth (superficial lesion). Tx: arthroscopy, curettage, and microfractures. 2B.2 Lesion measuring >10mm in diameter and >5mm in depth. Tx: open surgery, osteochondral graft, or mosaicoplasty. 3 Type 1 or 2 lesions associated with lateral instability of the ankle Tx: ligament repair. 4 With limb deformities 4A Types 1 or 2 lesions with hindfoot deformity = varus or valgus calcaneus Tx: varus or valgus calcaneal osteotomy. 4B Type 1 or 2 lesion with supramalleolar deformity of distal tibia (varus or valgus) Tx: varus or valgus supramalleolar osteotomy. Tx: treatment. Volume 15, Issue 1, January-April The Journal of the Foot & Ankle (eISSN 2675-2980) is published quarterly in April, August, and December, with the purpose of disseminating papers on themes of Foot and Ankle Medicine and Surgery and related areas. The Journal offers free and open access to your content on our website. All papers are already published with active DOIs. -
Anterior Reconstruction Techniques for Cervical Spine Deformity
Neurospine 2020;17(3):534-542. Neurospine https://doi.org/10.14245/ns.2040380.190 pISSN 2586-6583 eISSN 2586-6591 Review Article Anterior Reconstruction Techniques Corresponding Author for Cervical Spine Deformity Samuel K. Cho 1,2 1 1 1 https://orcid.org/0000-0001-7511-2486 Murray Echt , Christopher Mikhail , Steven J. Girdler , Samuel K. Cho 1Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA Department of Orthopaedics, Icahn 2 Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, School of Medicine at Mount Sinai, 425 NY, USA West 59th Street, 5th Floor, New York, NY, USA E-mail: [email protected] Cervical spine deformity is an uncommon yet severely debilitating condition marked by its heterogeneity. Anterior reconstruction techniques represent a familiar approach with a range Received: June 24, 2020 of invasiveness and correction potential—including global or focal realignment in the sagit- Revised: August 5, 2020 tal and coronal planes. Meticulous preoperative planning is required to improve or prevent Accepted: August 17, 2020 neurologic deterioration and obtain satisfactory global spinal harmony. The ability to per- form anterior only reconstruction requires mobility of the opposite column to achieve cor- rection, unless a combined approach is planned. Anterior cervical discectomy and fusion has limited focal correction, but when applied over multiple levels there is a cumulative ef- fect with a correction of approximately 6° per level. Partial or complete corpectomy has the ability to correct sagittal deformity as well as decompress the spinal canal when there is an- terior compression behind the vertebral body. -
Post–Vertebral Augmentation Back Pain: ORIGINAL RESEARCH Evaluation and Management
Post–Vertebral Augmentation Back Pain: ORIGINAL RESEARCH Evaluation and Management S. Kamalian BACKGROUND AND PURPOSE: Vertebral augmentation is an established treatment for painful osteo- R. Bordia porotic vertebral fractures of the spine. Nevertheless, patients may continue to have significant back pain afterward. The purpose of this study was to assess the source of persistent or recurrent back pain A.O. Ortiz following vertebral augmentation. MATERIALS AND METHODS: Our institutional review board approved this study. We evaluated 124 consecutive patients who underwent vertebral augmentation for painful osteoporotic vertebral frac- tures. All patients were evaluated after 3 weeks, 3 months, and 1 year following their procedure. Patients with any type of back pain after their procedure were examined under fluoroscopy. RESULTS: Thirty-four of 124 (27%) patients were men, and 90/124 (73%) were women. Persistent or recurrent back pain, not due to a new fracture or a failed procedure, was present in 29/124 (23%) patients. The source of pain was most often attributed to the sacroiliac and/or lumbar facet joints (25/29 or 86%). Seventeen of 29 (59%) patients experienced immediate relief after facet joint injection of a mixture of steroid and local anesthetic agents. The remaining 12 (41%) had relief after additional injections. Ten (34%) patients ultimately required radio-frequency neurolysis for long-term relief. CONCLUSIONS: Back pain after vertebral augmentation may not be due to a failed procedure but rather to an old or a new pain generator, such as an irritated sacroiliac or lumbar facet joint. This is of importance not only for further pain management of these patients but also for designing trials to compare the efficacy of vertebral augmentation to other treatments. -
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. -
Procedure Codes
NEW YORK STATE MEDICAID PROGRAM ORDERED AMBULATORY PROCEDURE CODES Ordered Ambulatory Procedure Codes Table of Contents GENERAL INFORMATION ---------------------------------------------------------------------------------------------------------------2 LABORATORY SERVICES INFORMATION-----------------------------------------------------------------------------------------2 RADIOLOGY INFORMATION------------------------------------------------------------------------------------------------------------3 MMIS MODIFIERS --------------------------------------------------------------------------------------------------------------------------6 RADIOLOGY SERVICES------------------------------------------------------------------------------------------------------------------7 DIAGNOSTIC RADIOLOGY (DIAGNOSTIC IMAGING) ------------------------------------------------------------------------7 DIAGNOSTIC ULTRASOUND SERVICES- -------------------------------------------------------------------------------------- 20 RADIOLOGIC GUIDANCE....................................................................................................................................25 BREAST, MAMMOGRAPHY --------------------------------------------------------------------------------------------------------- 26 BONE/JOINT STUDIES --------------------------------------------------------------------------------------------------------------- 26 RADIATION ONCOLOGY SERVICES --------------------------------------------------------------------------------------------- 27 NUCLEAR -
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). -
Effectiveness of Distal Tibial Osteotomy
Nozaka et al. BMC Musculoskeletal Disorders (2020) 21:31 https://doi.org/10.1186/s12891-020-3061-7 RESEARCH ARTICLE Open Access Effectiveness of distal tibial osteotomy with distraction arthroplasty in varus ankle osteoarthritis Koji Nozaka* , Naohisa Miyakoshi, Takeshi Kashiwagura, Yuji Kasukawa, Hidetomo Saito, Hiroaki Kijima, Shuichi Chida, Hiroyuki Tsuchie and Yoichi Shimada Abstract Background: In highly active older individuals, end-stage ankle osteoarthritis has traditionally been treated using tibiotalar arthrodesis, which provides considerable pain relief. However, there is a loss of ankle joint movement and a risk of future arthrosis in the adjacent joints. Distraction arthroplasty is a simple method that allows joint cartilage repair; however, the results are currently mixed, with some reports showing improved pain scores and others showing no improvement. Distal tibial osteotomy (DTO) without fibular osteotomy is a type of joint preservation surgery that has garnered attention in recent years. However, to our knowledge, there are no reports on DTO with joint distraction using a circular external fixator. Therefore, the purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator for treating ankle osteoarthritis. Methods: A total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed, followed by angled osteotomy and correction of the distal tibia; the ankle joint was then stabilized after its condition improved. An external fixator was used in all patients, and joint distraction of approximately 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery. Results: The anteroposterior and lateral mortise angle during weight-bearing, talar tilt angle, and anterior translation of the talus on ankle stress radiography were improved significantly (P < 0.05). -
Two-Level Cervical Corpectomy—Long-Term Follow-Up Reveals the High Rate of Material Failure in Patients, Who Received an Anterior Approach Only
Neurosurgical Review (2019) 42:511–518 https://doi.org/10.1007/s10143-018-0993-6 ORIGINAL ARTICLE Two-level cervical corpectomy—long-term follow-up reveals the high rate of material failure in patients, who received an anterior approach only Simon Heinrich Bayerl1 & Florian Pöhlmann1 & Tobias Finger1 & Vincent Prinz1 & Peter Vajkoczy 1 Received: 25 August 2017 /Revised: 20 November 2017 /Accepted: 5 December 2017 /Published online: 18 June 2018 # Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract In contrast to a one-level cervical corpectomy, a multilevel corpectomy without posterior fusion is accompanied by a high material failure rate. So far, the adequate surgical technique for patients, who receive a two-level corpectomy, remains to be elucidated. The aim of this study was to determine the long-term clinical outcome of patients with cervical myelopathy, who underwent a two-level corpectomy. Outcome parameters of 21 patients, who received a two-level cervical corpectomy, were retrospectively analyzed concerning reoperations and outcome scores (VAS, Neck Disability Index (NDI), Nurick scale, mod- ified Japanese Orthopaedic Association score (mJOAS), Short Form 36-item Health Survey Questionnaire (SF-36)). The failure rate was determined using postoperative radiographs. The choice over the surgical procedures was exercised by every surgeon individually. Therefore, a distinction between two groups was possible: (1) anterior group (ANT group) with a two-level corpectomy and a cervical plate, (2) anterior/posterior group (A/P group) with two-level corpectomy, cervical plate, and addi- tional posterior fusion. Both groups benefitted from surgery concerning pain, disability, and myelopathy. While all patients of the A/P group showed no postoperative instability, one third of the patients of the ANT group exhibited instability and clinical deterioration. -
Automated Percutaneous and Endoscopic Discectomy
Corporate Medical Policy Automated Percutaneous and Endoscopic Discectomy File Name: percutaneous_discectomy Origination: 9/1991 Last CAP Review: 5/2021 Next CAP Review: 5/2022 Last Review: 5/2021 Description of Procedure or Service Surgical management of herniated intervertebral discs most commonly involves discectomy or microdiscectomy, performed manually through an open incision. Automated percutaneous discectomy involves placement of a probe within the intervertebral disc under image guidance with aspiration of disc material using a suction cutting device. Removal of disc herniations under endoscopic visualization is also being investigated. Endoscopic discectomy involves the percutaneous placement of a working channel under image guidance, followed by visualization of the working space and instruments through an endoscope, and aspiration of disc material. Back pain or radiculopathy related to herniated discs is an extremely common condition and a frequent cause of chronic disability. Although many cases of acute low back pain and radiculopathy will resolve with conservative care, a surgical decompression is often considered when the pain is unimproved after several months and is clearly neuropathic in origin, resulting from irritation of the nerve roots. Open surgical treatment typically consists of discectomy, in which the extruding disc material is excised. When performed with an operating microscope the procedure is known as microdiscectomy. Minimally invasive options have also been researched, in which some portion of the disc is removed or ablated, although these techniques are not precisely targeted at the offending extruding disc material. Ablative techniques include laser discectomy and radiofrequency (RF) decompression. In addition, intradiscal electrothermal annuloplasty is another minimally invasive approach to low back pain. -
The Need for Structural Allograft Biomechanical Guidelines
8 The Need for Structural Allograft Biomechanical Guidelines Satoshi Kawaguchi, MD Robert A. Hart, MD Abstract Because of their osteoconductive properties, structural bone allografts retain a theoretic advantage in biologic performance compared with artifi cial interbody fusion devices and endoprostheses. Current regulations have addressed the risks of disease transmission and tissue contamination, but comparatively few guidelines exist regarding donor eligibility and bone processing issues with a potential effect on the mechanical integrity of structural allograft bone. The lack of guidelines appears to have led to variation among allograft providers in terms of processing and donor screening regarding issues with recognized mechanical effects. Given the relative lack of data on which to base reasonable screening standards, a basic biomechanical evaluation was performed on one source of structural bone allograft, the femoral ring. Of the tested parameters, the minimum and maximum cortical wall thicknesses of femoral ring allograft were most strongly correlated with the axial compressive load to failure of the graft, suggesting that cortical wall thickness may be a useful screening tool for compressive resistance expected from fresh cortical bone allograft. Development of further biomechanical and clinical data to direct standard development appears warranted. Instr Course Lect 2015;64:87–93. Surgical implantation of structural al- form with limited anatomic modifi - by the US FDA as well as through vol- lograft bone continues to increase de- cations, modern tissue processing in- untary participation with the American spite advances in modern alternatives cludes preparations of amalgams of Association of Tissue Banks (AATB). to allograft, including spine interbody allograft bone tissue of specifi c shapes Guidelines for allograft bone products fusion devices and peripheral joint en- and sizes to suit specifi c surgical needs. -
Vertebral Augmentation ICD 9 Codes: Osteoporosis 733. 0, Vertebra
BRIGHAM AND WOMEN’S HOSPITAL Department of Rehabilitation Services Physical Therapy Standard of Care: Vertebral Augmentation ICD 9 Codes: Osteoporosis 733. 0, Vertebral Fracture closed 805.8, Pathological fracture of Vertebrae 733.13 Vertebral augmentation, known as vertebroplasty and kyphoplasty, is a minimally invasive procedure that is used to treat vertebral fractures. Vertebral fractures are the most common skeletal injury associated with osteoporosis, and it is estimated that more than 750,000 occur annually in the United States.1 Up to one quarter of people over 50 years of age will have at least one vertebral fracture in their life time secondary to osteoporosis.2 According to the World Health Organization (WHO), the operational definition of osteoporosis is a bone density measure >2.5 standard deviations (SD) below the mean of young healthy adults of similar race and gender.3 Primary osteoporosis is related to the changes in postmenopausal women secondary to reduction of estrogen levels and related to age-related loss of bone mass. Secondary osteoporosis is the loss of bone caused by an agent or disease process. 1,4 (See Osteoporosis SOC) The severity of vertebral fractures can be assessed by the Genat semiquantitative method. Commonly used by radiologists, this scale assesses the severity of the fracture visually and has been shown to be reliable.5 Genat Semiquantitive Grading System for Vertebral Deformity5 Grade 0- normal vertebral height Grade 1- minimal fracture- 20-25% height decrease Grade 2- moderate fracture- 25-40% height decrease Grade 3-severe- >40% height decrease Standard methods of diagnosing vertebral fractures are imaging, including the following: CT scan, MRI, and radiography. -
Procedure Codes No Longer Requiring Prior
Procedure Code Description Removal of total disc arthroplasty (artificial disc), anterior approach, each additional 0095T interspace, cervical (List separately in addition to code for primary procedure) Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, cervical (List separately in addition to code for 0098T primary procedure) Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), each additional interspace, lumbar 0163T (List separately in addition to code for primary procedure) Removal of total disc arthroplasty, (artificial disc), anterior approach, each additional 0164T interspace, lumbar (List separately in addition to code for primary procedure) Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, lumbar (List separately in addition to code for 0165T primary procedure) Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound 0228T guidance, cervical or thoracic; single level Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; each additional level (List separately in addition to code 0229T for primary procedure) Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound 0230T guidance, lumbar or sacral; single level Injection(s), anesthetic agent and/or steroid, transforaminal epidural,