Coding & Reimbursement Task Force Tackles Growing List of Issues, Welcomes Input

In response to continued downward pressure from government and commercial payers on spine surgery coverage and reimbursement, the ISASS Coding & Reimbursement Task Force continues to evaluate policies that may be detrimental to optimal patient care, and that may unnecessarily or punitively reduce physician reimbursement. 

Under the leadership of Chairman Morgan Lorio, MD, the Task Force’s work is seemingly endless; in July, the Task Force issued a statement on coding for SI joint fusions, following changes issued by the CPT Editorial Panel, effective July 1st. The new category III code to be used for minimally invasive SI joint fusion may cause confusion with physician offices, and could lead to non-coverage of this procedure by some payers.See “Statement on Coding Changes for Minimally Invasive SI Joint Fusion”.

Recently, the Task Force developed two comment letters to CMS, as part of the public comment period on regulations expected to go into effect in January 2014. The first letter “Comments on CMS Proposed Rule (CMS-1601-P) Section III(A) Regarding Changes to IDE Coverage Process” expresses concerns with proposed policy changes that set unrealistic trial endpoints (at least for spine surgery-related studies), and that may negatively impact clinical study enrollment and completion. The second letter to CMS “Comments on CMS Proposed Rule (CMS-1600-P) – Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Medicare Part B for CY 2014” expresses opposition to significant reductions in reimbursement for many procedures performed in a physician’s office, and most notably kyphoplasty and vertebroplasty.

The Task Force greatly welcomes input from ISASS members: we are currently assessing new non-coverage policies issued by Aetna and United Healthcare for use of PEEK cages in cervical fusions, and are beginning to hear stories of denials in the field. Our goal is to develop guidance for our members, and to craft a letter to those carriers, articulating our concerns with a policy that seemingly puts their financial interests above those of our patients’ well-being.

Finally, please know that our Task Force welcomes input on issues that may be adversely impacting the appropriate delivery of care for our patients. If you feel that ISASS should get involved in advocacy on a specific issue with a government or commercial payer, please contact us. To contact the Coding & Reimbursement Task Force, please email us at Kristy@isass.org.

The Coding & Reimbursement Task Force is charged with:

1. identifying spinal surgery-related coding and reimbursement issues that may adversely impact patient access to medically indicated spine surgeries;
2. developing for the Board’s approval advocacy action plans on the society’s behalf to address those issues; and,
3. assisting in the execution of those advocacy action plans as appropriate and necessary.

The full roster of the Task Force includes:

Morgan P. Lorio, MD, FACS, of Bristol, Tennessee, is the chair of the ISASS Coding & Reimbursement Task Force.
Josh Auerbach, MD, New York, NY
Doug Beard, MD, Fort Collins, CO
Mauro Cataletto, MD, Minneola, NY
Terrence Julien, MD, Morgantown, WV
Scott Kitchel, MD, Eugene, OR
Richard Kube, MD, Peoria, IL
Isadore Lieberman, MD, Plano, TX
Morgan Lorio, MD, Bristol, TN – Chair
Paul Park, MD, Ann Arbor, MI
Tony Schnuerer, PA, San Diego, CA
Paul Schwaegler, MD, Seattle, WI

In addition to our ISASS members, the Task Force has created an advisory body of coding & reimbursement experts to help inform its priorities and activities. This advisory body includes:

Barbara Cataletto, MBA, Minneola, NY
Jolayne Fisher, Woodbury, MN
Kelli Hallias, Minnetonka MN
Tim Hunter, Washington, DC
Cindy Vandenbosch, Billings, MT
Jen Varela, San Diego, CA