Issue link: https://beckershealthcare.uberflip.com/i/772947
18 Executive Briefing The study was published in a 2015 issue of the International Journal for Spine Surgery. The company's five-year data also supports decompression and Interlaminar Stabilization® as an effective treatment for patients with moderate-to-severe spinal stenosis. "If you can define the patient group, the evidence is clear that moderate to severe spinal stenosis patients — those with a high VAS and ODI scores — can do well with Interlaminar Stabilization®," says Dr. Mathews. "If you select the right procedure, you can do better than the Medicare data set showing simple decompression and spinal fusion, both of which have about a 9 percent per year failure rate. The coflex® device has a lower overall failure rate." Payment trends Until recently, payers also existed within the two-bucket system, creating a reimbursement framework around simple decompression or fusion with nothing in between. However, since Paradigm Spine achieved FDA approval for coflex®, Interlaminar Stabilization® has gained traction among surgeons across the country, and payers are taking notice. CMS granted Interlaminar Stabilization® new reimbursement codes for 2017 in ambulatory surgery centers and third-party payers may be expected to follow. With the payment codes intact, surgeons can take the procedure to an outpatient ASC for additional clinical quality and reduced costs when the patient is appropriately indicated. "The rules changed in 2015 and now in 2017 we can see a significant policy shift toward traditional procedures that were only being done in the inpatient setting going into the outpatient setting," says Dr. Mathews. "It's a pivot shift from everything being inpatient and nothing allowed outpatient to CMS realizing that there is safety and efficacy in the procedure. Now patients and surgeons may have the ability to choose the site of service that fits their medical preference and needs." The new codes for Interlaminar Stabilization® and final ASC payment indicator are: 1. CPT 22867: Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar, single level: $10,541 2. CPT 22868: Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar, second level: Packaged, no separate payment 3. CPT 22869: Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar, single level: $10,541 4. CPT 22870: Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; second level: Packaged, no separate payment By comparison to the inpatient setting, reimbursement for some spinal fusions in the ASC setting covers less of the procedure. CMS de-emphasizes spinal fusion with their new reimbursement policy — providing less for these materials-heavy procedures with the potential for re-operations — and places emphasis on motion-sparing surgeries such as Interlaminar Stabilization®. Milliman recently prepared a report titled "Utilization and Cost of Surgery for Lumbar Spinal Stenosis in a Commercially Insured Population" which found if decompression and Interlaminar Stabilization® replaced 20 percent to 40 percent of the primary lumbar fusion surgeries, there would be around $1.77 in savings per member per month. However, Dr. Mathews notes the patient's safety and medical conditions must dictate the site of service over any financial considerations. ASCs have proven to all stakeholders that safety, quality and lower costs are possible for spinal procedures. "There is no doubt that the wrong procedure on the wrong patient at the wrong site of service doesn't benefit anyone," he says. "If one is able to have the choice of site of service, have input on where the procedure is done, and their anesthesiologist and internist think their procedure could be safely done in the outpatient ASC, then the coding changes open up that opportunity." n "Now patients and surgeons may have the ability to choose the site of service that fits their medical preference and needs." - Dr. Hallett Mathews Sponsored by The coflex® Interlaminar Stabilization® device is an FDA-approved treatment for lumbar spinal stenosis backed by Level 1 evidence out to 5 years. The coflex® device meets an unmet clinical need for a broad universe of lumbar spinal stenosis patients. These are patients with moderate to severe leg and back pain symptoms that may require a more extensive decompression, but don't require the rigid permanence of fusion. Patients that receive the coflex® device typically experience immediate relief of their stenosis symptoms while maintaining mobility and flexibility in the treated area. The coflex® Interlaminar Stabilization® device is manufactured by Paradigm Spine, LLC (New York, NY), an innovative global leader in non-fusion spinal implant technology.