ISASS supports decision making at the physician-patient level based on medical necessity and achieving the best outcomes to address the patient’s medical condition. Medical necessity should not be determined by a mere administrative code reporting system such as CPT. Dr. Kube, who performed the first Minimally Invasive Sacroiliac Joint Fusion using traditional orthopedic techniques, served on the committee that drafted this statement about coverage of minimally invasive sacroiliac joint fusion procedures. Prior to the July 1st implementation of CPT category III code 0334T, surgeons reported and were reimbursed for ALL sacroiliac joint fusion procedures when medically necessary, including minimally invasive, through the use of CPT code 27280.
To determine procedural approach prevalence associated with CPT code 27280, ISASS and the Society of Minimally Invasive Spine Surgeons conducted a survey of surgeons, and found that in 2012, nearly 90 percent of all SIJ fusions were performed using a minimally invasive approach. Yet despite the evidence that the MIS approach is by far the predominant approach, and has since 2011 become the standard of care for a select subset of patients, surgeons are now required to report a temporary, category III code (0334T) to describe their work. We cannot think of any other situation in which the standard of care for a given treatment has moved from a category I code to a category III code after being performed for four years with no discussion of coding appropriateness; we believe that payers, including Medicare, should continue to cover and pay for this procedure regardless of the coding change.
To read the statement in its entirety, click here.