LCD Reference Article Response To Comments Article

Response to Comments: Cervical Fusion

A59802

Expand All | Collapse All
Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A59802
Original ICD-9 Article ID
Not Applicable
Article Title
Response to Comments: Cervical Fusion
Article Type
Response to Comments
Original Effective Date
06/27/2024
Revision Effective Date
N/A
Revision Ending Date
N/A
Retirement Date
N/A

CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

N/A

Article Guidance

Article Text

The following are the comment summaries and contractor responses for Novitas Solutions Proposed Local Coverage Determination (LCD) DL39793 Cervical Fusion which was posted for comment on February 15, 2024, and presented at the August 16, 2023 Multi-MAC Contractor Advisory Committee (CAC) Meeting and March 1, 2024 Open Meeting. All comments were reviewed and incorporated into the final LCD where applicable .

Response To Comments

Number Comment Response
1

A comment was received that the limitation of asymptomatic myelopathy (regardless of severity on imaging findings) as not reasonable and necessary should be removed. The commenter states there are situations when a clinically significant, even if asymptomatic) myelopathy may require surgical intervention and should be left to provider discretion.

Thank you for your comments. There was not literature to support a role for surgical intervention in this population. If there is literature to expand to this group, it can be submitted through the LCD reconsideration process.  

2

HCA Regulatory Compliance Support request clarification Under Limitations, for item 1 in the section “Exceptions to conservative therapy requirement for decompression of symptomatic cervical nerve root impingement:”, which scale is being referenced in relation to “Cervical myelopathy class III or above”?
For Indication C.4. “Deformities that include the cervical spine including when:”, the last criteria should be revised to “OR progression of deformity” rather than “AND progression of deformity”. Research published via the ISSG has demonstrated severe disability associated with cervical deformities regardless of deformity progression. Two articles were submitted showing threshold values for pain and disability for cervical deformity which delineates that one does not need to have deformity progression for pain and disability, the deformity alone can cause pain and disability without progression. 

Thank you for your comments. The classification system described by Ranawat can be found in the Evidence Section of the LCD under “Cervical Myeloradiculopathy (Mixed).” Based on the submitted literature we agree there may be a role for correction of cervical deformity in the presence of pain and disability without deformity progression; therefore the “AND” has been changed to “OR.”

N/A

Coding Information

Bill Type Codes

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Code Description

Please accept the License to see the codes.

N/A

CPT/HCPCS Codes

Please accept the License to see the codes.

N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

Bill Type Codes

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Code Description

Please accept the License to see the codes.

N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
N/A
SAD Process URL 1
N/A
SAD Process URL 2
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
06/21/2024 06/27/2024 - N/A Currently in Effect You are here

Keywords

N/A