Evicore MSK Spine Surgery PA List (Updated 13 January 2020)
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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. -
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). -
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. -
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 -
Clinical Guidelines
CLINICAL GUIDELINES Interventional Pain Management Services Version 1.0.2019 Clinical guidelines for medical necessity review of comprehensive musculoskeletal management services. © 2019 eviCore healthcare. All rights reserved. Regence: Comprehensive Musculoskeletal Management Guidelines V1.0.2019 Interventional Pain Management CMM-200: Epidural Steroid Injections (ESI) 3 CMM-201: Facet Joint Injections/Medial Branch Blocks 17 CMM-202: Trigger Point Injections 21 CMM-203: Sacroiliac Joint Injections 32 CMM-204: Prolotherapy 37 CMM-207: Epidural Adhesiolysis 40 CMM-208: Radiofrequency Joint Ablations/Denervations 44 CMM-209: Regional Sympathetic Blocks 51 CMM 210: Implantable Intrathecal Drug Delivery Systems 57 CMM-211: Spinal Cord Stimulators 65 CMM-308: Thermal Intradiscal Procedures 66 CMM-310: Manipulation of the Spine Under Anesthesia 71 ______________________________________________________________________________________________________ © 2019 eviCore healthcare. All Rights Reserved. Page 2 of 73 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www.eviCore.com Regence: Comprehensive Musculoskeletal Management Guidelines V1.0.2019 CMM-200: Epidural Steroid Injections (ESI) CMM-200.1: Definitions 4 CMM-200.2: General Guidelines 5 CMM-200.3: Indications: Selective Nerve Root Block (SNRB) 6 CMM-200.4: Indications: Epidural Steroid Injections 7 CMM-200.5: Non-Indications: SNRB 8 CMM-200.6: Non-Indications: ESI 8 ® CMM-200.7: Procedure (CPT ) Codes 9 CMM-200.8: References 10 ______________________________________________________________________________________________________ -
TESSYS Technique with Small Grade of Facetectomy Has Potential Biomechanical Advantages Compared to the In-Out TED with Intact Articular Process : an In-Silico Study
TESSYS Technique With Small Grade of Facetectomy Has Potential Biomechanical Advantages Compared to the In-Out TED With Intact Articular Process : An In-Silico Study Jingchi Li West China Hospital/West China School of Medicine for Sichuan University Chen Xu Changzheng Hospital Aliated to the Naval Medical University Xiaoyu Zhang Aliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine Zhipeng Xi Aliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine Mengnan Liu Macau University of Science and Technology Zhongxin Fang Xihua University Nan Wang Aliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine Lin Xie ( [email protected] ) Aliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine Yueming Song West China Hospital/West China School of Medicine for Sichuan University Research Article Keywords: Biomechanical deterioration, Transforaminal endoscopic discectomy, Endoscopic dynamic drill, Facetectomy, Iatrogenic annulus injury Posted Date: April 26th, 2021 Page 1/27 DOI: https://doi.org/10.21203/rs.3.rs-429749/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Version of Record: A version of this preprint was published at BMC Musculoskeletal Disorders on July 10th, 2021. See the published version at https://doi.org/10.1186/s12891-021-04504-1. Page 2/27 Abstract Background: The facetectomy was reported as an important procedure in both in-out and out-in (i.e. transforaminal endoscopic spine system (TESSYS)) techniques in the transforaminal endoscopic discectomy (TED), and which was also related to the deterioration of postoperative biomechanical environment and related poor prognosis. -
Priority Health Spine and Joint Code List
Priority Health Joint Services Code List Category CPT® Code CPT® Code Description Joint Services 23000 Removal of subdeltoid calcareous deposits, open Joint Services 23020 Capsular contracture release (eg, Sever type procedure) Joint Services 23120 Claviculectomy; partial Joint Services 23130 Acromioplasty or acromionectomy, partial, with or without coracoacromial ligament release Joint Services 23410 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute Joint Services 23412 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open;chronic Joint Services 23415 Coracoacromial ligament release, with or without acromioplasty Joint Services 23420 Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty) Joint Services 23430 Tenodesis of long tendon of biceps Joint Services 23440 Resection or transplantation of long tendon of biceps Joint Services 23450 Capsulorrhaphy, anterior; Putti-Platt procedure or Magnuson type operation Joint Services 23455 Capsulorrhaphy, anterior;with labral repair (eg, Bankart procedure) Joint Services 23460 Capsulorrhaphy, anterior, any type; with bone block Joint Services 23462 Capsulorrhaphy, anterior, any type;with coracoid process transfer Joint Services 23465 Capsulorrhaphy, glenohumeral joint, posterior, with or without bone block Joint Services 23466 Capsulorrhaphy, glenohumeral joint, any type multi-directional instability Joint Services 23470 ARTHROPLASTY, GLENOHUMERAL JOINT; HEMIARTHROPLASTY ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL SHOULDER [GLENOID -
Musculoskeletal Surgical Procedures Requiring Prior Authorization (Effective 11.1.2020)
Musculoskeletal Surgical Procedures Requiring Prior Authorization (Effective 11.1.2020) Procedure Code Description ACL Repair 27407 Repair, primary, torn ligament and/or capsule, knee; cruciate ACL Repair 27409 Repair, primary, torn ligament and/or capsule, knee; collateral and cruciate ligaments ACL Repair 29888 Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction Acromioplasty and Rotator Cuff Repair 23130 Acromioplasty Or Acromionectomy, Partial, With Or Without Coracoacromial Ligament Release Acromioplasty and Rotator Cuff Repair 23410 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute Acromioplasty and Rotator Cuff Repair 23412 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic Acromioplasty and Rotator Cuff Repair 23415 Coracoacromial Ligament Release, With Or Without Acromioplasty Acromioplasty and Rotator Cuff Repair 23420 Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty) Arthroscopy, Shoulder, Surgical; Decompression Of Subacromial Space With Partial Acromioplasty, With Coracoacromial Ligament (Ie, Arch) Release, When Performed (List Separately In Addition Acromioplasty and Rotator Cuff Repair 29826 To Code For Primary Procedure) Acromioplasty and Rotator Cuff Repair 29827 Arthroscopy, shoulder, surgical; with rotator cuff repair Allograft for Spinal Fusion [BMP] 20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only Ankle Fusion 27870 Arthrodesis, ankle, open Ankle Fusion -
Biomechanical Evaluation of Relationship of Screw Pullout
ORIGINAL ARTICLE Biomechanical Evaluation of Relationship of Screw Pullout Strength, Insertional Torque, and Bone Mineral Density in the Cervical Spine Charles Alan Reitman, MD, Lyndon Nguyen, and Guy R. Fogel help prevent implant loosening and add rigidity to the plate- Background: Understanding of implant failure mechanisms is im- screw construct. Some screws actually lock to the plate, while portant in the successful utilization of anterior cervical plates. Many in most cases, there is some kind of blocking plate or screw variables influence screw purchase, including the quality of the bone. head expansion to secure the screw to the plate. In these cases, The purpose of this study was to assess the relationship of screw pull- out and screw insertional torque across a wide range of bone mineral the screws are initially placed securely per the surgeon’s own densities (BMDs). perception, in most instances without specific torque control. Screw pullout and stripping (exceeding maximal inser- Methods: A total of 54 cervical vertebrae in 12 cervical spines were tional torque) are possible modes of failure. Some factors af- evaluated for BMD using dual-energy x-ray absorptiometry scan- fecting the pullout strength of a cancellous bone screw are spe- ning. Actual and perceived peak torques of 3.5-mm anterior cervical cific to the screw design and include the major diameter of the screws were determined at each level followed by screw pullout screw, the length of engagement of the thread, and screw strength testing. thread depth and pitch.4 Furthermore, tapping was found to Results: A high correlation was observed between screw pullout reduce pullout force by an average of 8% compared with non- strength and BMD. -
Osteotomy Around the Knee: Evolution, Principles and Results
Knee Surg Sports Traumatol Arthrosc DOI 10.1007/s00167-012-2206-0 KNEE Osteotomy around the knee: evolution, principles and results J. O. Smith • A. J. Wilson • N. P. Thomas Received: 8 June 2012 / Accepted: 3 September 2012 Ó Springer-Verlag 2012 Abstract to other complex joint surface and meniscal cartilage Purpose This article summarises the history and evolu- surgery. tion of osteotomy around the knee, examining the changes Level of evidence V. in principles, operative technique and results over three distinct periods: Historical (pre 1940), Modern Early Years Keywords Tibia Osteotomy Knee Evolution Á Á Á Á (1940–2000) and Modern Later Years (2000–Present). We History Results Principles Á Á aim to place the technique in historical context and to demonstrate its evolution into a validated procedure with beneficial outcomes whose use can be justified for specific Introduction indications. Materials and methods A thorough literature review was The concept of osteotomy for the treatment of limb defor- performed to identify the important steps in the develop- mity has been in existence for more than 2,000 years, and ment of osteotomy around the knee. more recently pain has become an additional indication. Results The indications and surgical technique for knee The basic principle of osteotomy (osteo = bone, tomy = osteotomy have never been standardised, and historically, cut) is to induce a surgical transection of a bone to allow the results were unpredictable and at times poor. These realignment and a consequent transfer of weight bearing factors, combined with the success of knee arthroplasty from a damaged area to an undamaged area of joint surface. -
The Costs and Benefits of Moving to the ICD-10 Code Sets
CHILDREN AND ADOLESCENTS This PDF document was made available from www.rand.org as a public CIVIL JUSTICE service of the RAND Corporation. EDUCATION ENERGY AND ENVIRONMENT Jump down to document HEALTH AND HEALTH CARE 6 INTERNATIONAL AFFAIRS POPULATION AND AGING The RAND Corporation is a nonprofit research PUBLIC SAFETY SCIENCE AND TECHNOLOGY organization providing objective analysis and effective SUBSTANCE ABUSE solutions that address the challenges facing the public TERRORISM AND HOMELAND SECURITY and private sectors around the world. TRANSPORTATION AND INFRASTRUCTURE U.S. NATIONAL SECURITY Support RAND Purchase this document Browse Books & Publications Make a charitable contribution For More Information Visit RAND at www.rand.org Explore RAND Science and Technology View document details Limited Electronic Distribution Rights This document and trademark(s) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non-commercial use only. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. This product is part of the RAND Corporation technical report series. Reports may include research findings on a specific topic that is limited in scope; present discus- sions of the methodology employed in research; provide literature reviews, survey instruments, modeling exercises, guidelines for practitioners and research profes- sionals, and supporting documentation;