GLN173-percutaneous-laser-disc-decompression-62287-S2348



In January, 2018, CPT code 62287 was moved from lines 346 CONDITIONS OF THE BACK AND SPINE WITH URGENT SURGICAL INDICATIONS, 361 SCOLIOSIS and 527 CONDITIONS OF THE BACK AND SPINE WITHOUT URGENT SURGICAL INDICATIONS to Guideline Note 173, attached to line 660. HCPCS code S2348 was moved to Guideline Note 173 and attached to line 660. Adapted from 1/18/2018 Meeting Materials. Minutes indicate the recommendation was accepted with minimal discussion. CPT code 62287 Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method, single or multiple levels, lumbar (e.g., manual or automated percutaneous discectomy, percutaneous laser discectomy)HCPCS code S2348 Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, using radiofrequency energy, single or multiple levels, lumbarQuestion: How should the Coverage Guidance - Minimally Invasive and Non-Corticosteroid Percutaneous Interventions for Low Back Pain – be applied to the Prioritized List?Question source: Evidence-based Guidelines Subcommittee (EbGS)Issue: EbGS has developed a draft Coverage Guidance on Minimally invasive and non-corticosteroid percutaneous interventions. This is one of a series of back pain Coverage Guidances HERC has completed:Advanced Imaging for Low Back Pain (2012)Non-pharmacologic, non-invasive interventions (2014)Pharmacologic and Herbal Therapies (2014)Lumbar Discography (2014)Artificial Disk Replacement (2014)Percutaneous Interventions for Low Back Pain (2014)Vertebroplasty, Kyphoplasty, and Sacroplasty (2016)Corticosteroid injections (2017)The Coverage Guidance reviewed minimally invasive discectomy, percutaneous laser decompression, ozone therapy injections, and radiofrequency denervation. The draft box language is as follows:HERC Coverage GuidanceMinimally invasive discectomy is recommended for coverage as an alternative to microdiscectomy or open discectomy, when discectomy is indicated (weak recommendation). The following are not recommended for coverage for low back pain:Percutaneous laser disc decompression (strong recommendation)Ozone therapy injections (strong recommendation)Radiofrequency denervation (weak recommendation)The greatest debate was around radiofrequency denervation. A deeper evidence dive was performed following testimony from OHSU pain physicians about the need to identify a subgroup of patients for which this was felt to be effective. Additional evidence was reviewed and EbGS deliberated about consideration of coverage for a highly selected subgroup, but the final EbGS decision was to make a weak recommendation against coverage.Current Prioritized List StatusLine:346Condition:CONDITIONS OF THE BACK AND SPINE WITH URGENT SURGICAL INDICATIONS (See Guideline Notes 37,60,64,65,100,101)Treatment:SURGICAL THERAPYICD-10:G83.4,?M43.10-M43.19,?M47.011-M47.27,?M48.00-M48.05,?M48.061-M48.08,?M50.00-M50.01,?M50.020-M50.11,?M51.04-M51.17,?M53.2X1-M53.2X9,?M54.10-M54.18,?Q06.8,?Q76.2CPT:20660-20665,?20930-20938,?21720,?21725,?22206-22226,?22532-22865,?29000-29046,?29710,?29720,?62287,?63001-63091,?63170,?63180-63200,?63270-63273,?63295-63610,?63650,?63655,?63685,?93792,?93793,?96150-96155,?97110-97124,?97140-97168,?97530,?97535,?98966-98969,?99051,?99060,?99070,?99078,?99184,?99201-99239,?99281-99285,?99291-99404,?99408-99449,?99468-99480,?99487,?99489,?99495,?99496,?99605-99607HCPCS:G0157-G0160,?G0248-G0250,?G0396,?G0397,?G0406-G0408,?G0425-G0427,?G0463-G0467,?G0508-G0511,?G0513,?G0514,?S2350,?S2351Line:527Condition:CONDITIONS OF THE BACK AND SPINE WITHOUT URGENT SURGICAL INDICATIONS (See Guideline Notes 37,60,64,65,100,101,161)Treatment:SURGICAL THERAPYICD-10:G95.0,?M40.00-M40.15,?M40.202-M40.57,?M42.00-M42.9,?M43.00-M43.28,?M43.8X1-M43.8X9,?M45.0-M45.9,?M46.1,?M46.40-M46.99,?M47.20-M47.28,?M47.811-M47.9,?M48.00-M48.05,?M48.061-M48.19,?M48.30-M48.38,?M48.8X1-M48.9,?M49.80-M49.89,?M50.10-M50.11,?M50.120-M50.93,?M51.14-M51.9,?M53.80-M53.9,?M54.10-M54.18,?M96.1-M96.4,?M99.20-M99.79,?Q06.0-Q06.3,?Q06.8-Q06.9,?Q76.0-Q76.2,?Q76.411-Q76.49,?S13.0XXA-S13.0XXD,?S23.0XXA-S23.0XXD,?S23.100A-S23.100D,?S23.110A-S23.110D,?S23.120A-S23.120D,?S23.122A-S23.122D,?S23.130A-S23.130D,?S23.132A-S23.132D,?S23.140A-S23.140D,?S23.142A-S23.142D,?S23.150A-S23.150D,?S23.152A-S23.152D,?S23.160A-S23.160D,?S23.162A-S23.162D,?S23.170A-S23.170D,?S33.0XXA-S33.0XXD,?S33.100A-S33.100D,?S33.110A-S33.110D,?S33.120A-S33.120D,?S33.130A-S33.130D,?S33.140A-S33.140D,?S34.3XXA-S34.3XXDCPT:20610,?20660-20665,?20930-20938,?21720,?21725,?22206-22226,?22532-22865,?27035,?27096,?27279,?29000-29046,?29710,?29720,?62287,?62322,?62323,?63001-63091,?63170,?63173-63200,?63270-63273,?63295-63610,?63650,?63655,?63685,?64483,?64484,?64493-64495,?93792,?93793,?96150-96155,?97110-97124,?97140-97168,?97530,?97535,?98966-98969,?99051,?99060,?99070,?99078,?99184,?99201-99239,?99281-99285,?99291-99404,?99408-99449,?99468-99480,?99487,?99489,?99495,?99496,?99605-99607HCPCS:G0157-G0160,?G0248-G0250,?G0260,?G0396,?G0397,?G0406-G0408,?G0425-G0427,?G0463-G0467,?G0508-G0511,?G0513,?G0514,?S2350,?S2351GUIDELINE NOTE 37, SURGICAL INTERVENTIONS FOR CONDITIONS OF THE BACK AND SPINE OTHER THAN SCOLIOSISLines 346,?527Spine surgery is included on Line 346 only in the following circumstances:Decompressive surgery is included on Line 346 to treat debilitating symptoms due to central or foraminal spinal stenosis, and only when the patient meets the following criteria:Has MRI evidence of moderate or severe central or foraminal spinal stenosis ANDHas neurogenic claudication ORHas objective neurologic impairment consistent with the MRI findings. Neurologic impairment is defined as objective evidence of one or more of the following:Markedly abnormal reflexesSegmental muscle weaknessSegmental sensory lossEMG or NCV evidence of nerve root impingementCauda equina syndromeNeurogenic bowel or bladderLong tract abnormalitiesForaminal or central spinal stenosis causing only radiating pain (e.g. radiculopathic pain) is included only on Line 527.Spinal fusion procedures are included on Line 346 for patients with MRI evidence of moderate or severe central spinal stenosis only when one of the following conditions are met:spinal stenosis in the cervical spine (with or without spondylolisthesis) which results in objective neurologic impairment as defined above ORspinal stenosis in the thoracic or lumbar spine caused by spondylolisthesis resulting in signs and symptoms of neurogenic claudication and which correlate with xray flexion/extension films showing at least a 5 mm translation ORpre-existing or expected post-surgical spinal instability (e.g. degenerative scoliosis >10 deg, >50% of facet joints per level expected to be resected)For all other indications, spine surgery is included on Line 527. The following interventions are not included on these lines due to lack of evidence of effectiveness for the treatment of conditions on these lines, including cervical, thoracic, lumbar, and sacral conditions: prolotherapylocal injectionsbotulinum toxin injectionintradiscal electrothermal therapytherapeutic medial branch blockcoblation nucleoplastypercutaneous intradiscal radiofrequency thermocoagulationradiofrequency denervationcorticosteroid injections for cervical painCorticosteroid injections for low back pain with or without radiculopathy are only included on Line 527. The development of this guideline note was informed by HERC coverage guidances on Percutaneous Interventions for Low Back Pain, Percutaneous Interventions for Cervical Spine Pain and Low Back Pain: Corticosteroid Injections. See CodesPlacement on the Prioritized List0275TPercutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (e.g., fluoroscopic, CT), single or multiple levels, unilateral or bilateral; lumbarNot on Prioritized List22899Unlisted procedure, spineAncillary62267Percutaneous aspiration within the nucleus pulosus, intervertebral disc, or paravertebral tissue for diagnostic purposesDiagnostic62287Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method, single or multiple levels, lumbar (e.g., manual or automated percutaneous discectomy, percutaneous laser discectomy)346 Conditions of back and spine with urgent surgical indications361 Scoliosis527 Conditions of the back and spine without urgent surgical indications62292Injection procedure for chemonucleolysis, including discography, intervertebral disc, single or multiple levels, lumbar660 CONDITIONS FOR WHICH CERTAIN INTERVENTIONS ARE UNPROVEN, HAVE NO CLINICALLY IMPORTANT BENEFIT OR HAVE HARMS THAT OUTWEIGH BENEFITS62380Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar66064635Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint66064636… each additional facet joint (List separately in addition to code for primary procedure)66064999Unlisted procedure, nervous system (applies to the nerve root and not the musculoskeletal system)AncillaryHCPCS Level II CodesS2348Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, using radiofrequency energy, single or multiple levels, lumbarSRNCHERC Staff Assessment:Minimally invasive discectomy – CPT code 62287 is already included on 346, 361, and 527. No change needed.Ozone therapy injections are not explicitly called out in the guideline. There is no specific CPT code for this. Clarification of intent is indicated.Radiofrequency denervation is currently non covered, place S2348 on Line 660 (currently listed as SRNC).Percutaneous laser disc decompression 62287 is currently on 2 funded and 1 unfunded line. These need to be removed and an entry in GN 37 to indicate its non-inclusion.HERC Staff Recommendations: ADD S2348 Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, using radiofrequency energy, single or multiple levels, lumbar to Line 660 (currently on SRNC)REMOVE 62287 Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method, single or multiple levels, lumbar (e.g., manual or automated percutaneous discectomy, percutaneous laser discectomy) from lines 346, 361, and 527. Place on line 660.Modify Guideline Note 37 as follows:GUIDELINE NOTE 37, SURGICAL INTERVENTIONS FOR CONDITIONS OF THE BACK AND SPINE OTHER THAN SCOLIOSISLines 346,?527Spine surgery is included on Line 346 only in the following circumstances:Decompressive surgery is included on Line 346 to treat debilitating symptoms due to central or foraminal spinal stenosis, and only when the patient meets the following criteria:Has MRI evidence of moderate or severe central or foraminal spinal stenosis ANDHas neurogenic claudication ORHas objective neurologic impairment consistent with the MRI findings. Neurologic impairment is defined as objective evidence of one or more of the following:Markedly abnormal reflexesSegmental muscle weaknessSegmental sensory lossEMG or NCV evidence of nerve root impingementCauda equina syndromeNeurogenic bowel or bladderLong tract abnormalitiesForaminal or central spinal stenosis causing only radiating pain (e.g. radiculopathic pain) is included only on Line 527.Spinal fusion procedures are included on Line 346 for patients with MRI evidence of moderate or severe central spinal stenosis only when one of the following conditions are met:spinal stenosis in the cervical spine (with or without spondylolisthesis) which results in objective neurologic impairment as defined above ORspinal stenosis in the thoracic or lumbar spine caused by spondylolisthesis resulting in signs and symptoms of neurogenic claudication and which correlate with xray flexion/extension films showing at least a 5 mm translation ORpre-existing or expected post-surgical spinal instability (e.g. degenerative scoliosis >10 deg, >50% of facet joints per level expected to be resected)For all other indications, spine surgery is included on Line 527. The following interventions are not included on these lines due to lack of evidence of effectiveness for the treatment of conditions on these lines, including cervical, thoracic, lumbar, and sacral conditions: prolotherapylocal injections (including ozone therapy injections)botulinum toxin injectionintradiscal electrothermal therapytherapeutic medial branch blockcoblation nucleoplastypercutaneous intradiscal radiofrequency thermocoagulationpercutaneous laser disc decompressionradiofrequency denervationcorticosteroid injections for cervical painCorticosteroid injections for low back pain with or without radiculopathy are only included on Line 527. The development of this guideline note was informed by HERC coverage guidances on Percutaneous Interventions for Low Back Pain, Percutaneous Interventions for Cervical Spine Pain, Low Back Pain: Corticosteroid Injections, and Low Back Pain: Minimally Invasive and Non-Corticosteroid Percutaneous Interventions. See NOTE 173, INTERVENTIONS THAT ARE UNPROVEN, HAVE NO CLINICALLY IMPORTANT BENEFIT OR HAVE HARMS THAT OUTWEIGH BENEFITS FOR CERTAIN CONDITIONS The following interventions are prioritized on Line 660 CONDITIONS FOR WHICH CERTAIN INTERVENTIONS ARE UNPROVEN, HAVE NO CLINICALLY IMPORTANT BENEFIT OR HAVE HARMS THAT OUTWEIGH BENEFITS:Procedure CodeIntervention DescriptionRationaleLast Review62287, S2348Percutaneous laser disc decompression Ozone therapy injectionsRadiofrequency denervationInsufficient evidence of effectivenessJanuary, 2018Coverage Guidance Blog ................
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