evekhm/cms_iom_500 huggingface dataset:
Proposed LCD - Cervical Fusion (DL39762)
ANDf. Substantial functional limitation is present such as severe neck pain, difficulty ambulating and decrease ability to perform ADLs or ability to maintain forward gaze.ANDg. Progression of deformityLimitationsCervical Fusion for the decompression or stabilization of the cervical spineis not reasonable and necessary when all the above criteria are not fulfilled.Provider QualificationsThe Medicare Program Integrity Manual states services will be considered reasonable and necessary only if performed by appropriately trained providers.Patient safety and quality of care mandate that healthcare professionals who perform cervical fusion are appropriately trained and credentialed by a formal residency/fellowship program. Credentialing or privileges are required for procedures performed in inpatient and outpatient settings.All aspects of care must be within the providers medical licensure and scope of practice. Reimbursement for procedures utilizing imaging techniques may be made to providers who meet training requirements for the procedures in this policy only if their respective state allows such in their practice act and formally licenses or certifies the practitioner to use and interpret these imaging modalities (ionizing radiation and associated contrast material, magnetic resonance imaging, ultrasound). At a minimum, training must cover and develop an understanding of anatomy and drug pharmacodynamics and kinetics as well as proficiency in diagnosis and management of disease, the technical performance of the procedure, and utilization of the required associated imaging modalities.Notice:Services performed for any given diagnosis must meet all the indications and limitations stated in this LCD, the general requirements for medical necessity as stated in CMS payment policy manuals, all existing CMS national coverage determinations, and all Medicare payment rules.
Proposed LCD - Cervical Fusion (DL39762)
DefinitionsAcute Painan unpleasant sensory and emotional experience associated with actual or potential tissue damage which is present for up to 6 weeks.7Baseline Pain-An initial measurement of the pain which is taken at a specified time point and used for comparison over time to look for changes in the pain levels.Cervical Radiculopathy-Pain in a radicular pattern in one or both upper extremities related to compression and irritation of one or more cervical nerve roots.8Chronic PainThe temporal definition of pain persisting at least 12 weeks after the onset of the acute pain.Conservative TherapyConsists of an appropriate combination of medication in therapeutic dosages (e.g., non-steroidal anti-inflammatory [NSAIDs], serotonin and norepinephrine reuptake inhibitors (SNRIs), analgesics, etc.) administered for a sufficient amount of time to determine efficacy, in combination with either physical therapy, spinal manipulation therapy, cognitive behavioral therapy (CBT), home exercise program, acupuncture, or other interventions based on the individuals specific presentation, physical findings, and imaging results.Consistent Improvement The progressive, incremental, and clinically meaningful improvement of physical signs or symptoms.Disability Activity limitations or participation restrictions in an individual with a health condition, disorder or disease.9Functional Impairment -A physical or functional or physiological impairment causing deviation from the normal function of a tissue or organ. This results in a significantly limited, impaired or delayed capacity to move, coordinate actions or perform physical activities and is exhibited by difficulties in one or more of the following areas: physical and motor tasks; independent movement; performing basic life functions.9GRADE A system developed by the GRADE Working Group to address the shortcomings of present grading systems in healthcare. The GRADE system uses a common, sensible, and transparent approach to grading the quality of evidence. The results of applying the GRADE system to clinical trial data are displayed in a table known as a GRADE profile.Hangmans Fracture- a bilateral fracture traversing the pars interarticularis of cervical vertebrae 2 (C2) with an associated traumatic subluxation of C2 on cervical vertebrae 3 (C3).10Multidisciplinary Biopsychosocial Rehabilitation (MBR) Targets physical as well as psychological and social aspects of pain and involves a team of healthcare providers with different professional backgrounds and training.
Proposed LCD - Cervical Fusion (DL39762)
Myelopathy-An inclusive term describing a compression of the spinal cord resulting in neurological deficits e.g., spasticity (sustained muscle contractions), hyperreflexia, pathologic reflexes, paresthesia affecting the extremities, muscle weakness, digit/hand clumsiness, or gait disturbance.11,12Nonspecific low back painBack pain that cannot be attributed to a specific disease or spinal pathology.Session-A session is a time period, which includes all procedures (e.g., SIJIs and RFA ablations) that are performed during the same day.Sustained and Constant Pain Relief- The pain relief must continue for the defined time period and without interruption or regression to the primary (index) pain.Symptomatic pseudarthrosis- (non-union of prior fusion) with radiological (e.g., CT or MRI) demonstration of non-union of prior fusion (lack of bridging bone or abnormal motion at fused segment) 12 months or more since fusion surgeryorwith radiographic evidence of hardware failure (fracture or displacement).13Unstable Spine-cervical spinal instability has been defined as destruction of either the anterior or posterior elements of the spine making them nonfunctional, more than 3.5 mm of displacement of one vertebra in relation to another or greater than 11 degrees of rotational difference between adjacent vertebrae.1,14Contractor Advisory MeetingA Multi-MAC Contractor Advisory Committee (CAC) Meeting was hosted by Noridian and includedNoridian Healthcare Solutions, CGS Administrators, National Government Services, Palmetto GBA, WPS Government Health Administrators, First Coast Service Options and Novitas Solutions on August 16, 2023. The transcript and audio for this meeting is posted on each MACs website. Feedback from the subject matter experts is included through the evidence summary.General InformationAssociated InformationN/ASources of InformationN/ABibliography
Proposed LCD - Cervical Fusion (DL39762)
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Proposed LCD - Cervical Fusion (DL39762)
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Proposed LCD - Cervical Fusion (DL39762)
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Proposed LCD - Cervical Fusion (DL39762)
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Proposed LCD - Cervical Fusion (DL39762)
Zou T, Wang PC, Chen H, Feng XM, Sun HH. Minimally invasive posterior cervical foraminotomy versus anterior cervical discectomy and fusion for cervical radiculopathy: a meta-analysis.Neurosurg Rev.2022;45(6):3609-3618.Gutman G, Rosenzweig DH, Golan JD. Surgical Treatment of Cervical Radiculopathy: Meta-analysis of Randomized Controlled Trials.Spine (Phila Pa 1976).2018;43(6):E365-E372.Fei Q, Li J, Su N, et al. Comparison between anterior cervical discectomy with fusion and anterior cervical corpectomy with fusion for the treatment of cervical spondylotic myelopathy: a meta-analysis.Ther Clin Risk Manag.2015;11:1707-1718.Han YC, Liu ZQ, Wang SJ, Li LJ, Tan J. Is anterior cervical discectomy and fusion superior to corpectomy and fusion for treatment of multilevel cervical spondylotic myelopathy? A systemic review and meta-analysis.PLoS One.2014;9(1):e87191.Li Z, Long C, Li B, Wei J. Efficacy and safety of surgical interventions for treating multilevel cervical spondylotic myelopathy via anterior approach: A network meta-analysis.Pain Physician.2019;22(4):E275.Montano N, Ricciardi L, Olivi A. Comparison of Anterior Cervical Decompression and Fusion versus Laminoplasty in the Treatment of Multilevel Cervical Spondylotic Myelopathy: A Meta-Analysis of Clinical and Radiological Outcomes.World Neurosurg.2019;130:530-536 e532.Wang T, Guo J, Long Y, Hou Z. Comparison of Two Anterior Reconstructive Techniques in the Treatment of 3-Level and 4 Level Cervical Spondylotic Myelopathy: A Meta-analysis of Last Decade.Geriatr Orthop Surg Rehabil.2022;13:21514593221124415.
Proposed LCD - Cervical Fusion (DL39762)
Schuermans VNE, Smeets A, van de Kar LGC, et al. A Systematic Review on Neurological Outcomes for Cervical Degenerative Myelopathy After Anterior Decompression Surgery: Motion Preservation vs Fusion.Int J Spine Surg.2022;16(6):969-976.El-Ghandour NMF, Soliman MAR, Ezzat AAM, Mohsen A, Zein-Elabedin M. The safety and efficacy of anterior versus posterior decompression surgery in degenerative cervical myelopathy: a prospective randomized trial.J Neurosurg Spine.2020:1-9.Xu L, Sun H, Li Z, Liu X, Xu G. Anterior cervical discectomy and fusion versus posterior laminoplasty for multilevel cervical myelopathy: A meta-analysis.Int J Surg.2017;48:247-253.Zhao CM, Chen Q, Zhang Y, Huang AB, Ding WY, Zhang W. Anterior cervical discectomy and fusion versus hybrid surgery in multilevel cervical spondylotic myelopathy: A meta-analysis.Medicine (Baltimore).2018;97(34):e11973.Lee NJ, Kim JS, Park P, Riew KD. A comparison of various surgical treatments for degenerative cervical myelopathy: a propensity score matched analysis.Global spine journal.2022;12(6):1109-1118.Medicine JH. Cervical Myelopathy. Johns Hopkins Medicine. Cervical Myelopathy. Accessed 11/14, 2023.Ranawat CS, O'Leary P, Pellicci P, Tsairis P, Marchisello P, Dorr L. Cervical spine fusion in rheumatoid arthritis.J Bone Joint Surg Am.1979;61(7):1003-1010.Gillick JL, Wainwright J, Das K. Rheumatoid arthritis and the cervical spine: a review on the role of surgery.International journal of rheumatology.2015;2015.
Proposed LCD - Cervical Fusion (DL39762)
Gillick JL, Wainwright J, Das K. Rheumatoid arthritis and the cervical spine: a review on the role of surgery.International journal of rheumatology.2015;2015.Nunez JH, Escudero B, Omiste I, et al. Outcomes of cervical arthroplasty versus anterior cervical arthrodesis: a systematic review and meta-analysis of randomized clinical trials with a minimum follow-up of 7-year.Eur J Orthop Surg Traumatol.2022.Peng Z, Hong Y, Meng Y, Liu H. A meta-analysis comparing the short- and mid- to long-term outcomes of artificial cervical disc replacement(ACDR) with anterior cervical discectomy and fusion (ACDF) for the treatment of cervical degenerative disc disease.Int Orthop.2022;46(7):1609-1625.Xing D, Ma XL, Ma JX, Wang J, Ma T, Chen Y. A meta-analysis of cervical arthroplasty compared to anterior cervical discectomy and fusion for single-level cervical disc disease.J Clin Neurosci.2013;20(7):970-978.Zhang Y, Lv N, He F, et al. Comparison of cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of cervical disc degenerative diseases on the basis of more than 60 months of follow-up: a systematic review and meta-analysis.BMC Neurol.2020;20(1):143.Fehlings MG, Martin AR, Tetreault LA, et al. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role of Baseline Magnetic Resonance Imaging in Clinical Decision Making and Outcome Prediction.Global Spine J.2017;7(3 Suppl):221S-230S.Zileli M, Maheshwari S, Kale SS, Garg K, Menon SK, Parthiban J. Outcome Measures and Variables Affecting Prognosis of Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations.Neurospine.2019;16(3):435-447.
Proposed LCD - Cervical Fusion (DL39762)
Costa F, Anania CD, Agrillo U, et al. Cervical Spondylotic Myelopathy: From the World Federation of Neurosurgical Societies (WFNS) to the Italian Neurosurgical Society (SINch) Recommendations.Neurospine.2023;20(2):415-429.Watanabe M, Chikuda H, Fujiwara Y, et al. Japanese Orthopaedic Association (JOA) Clinical practice guidelines on the Management of Cervical Spondylotic Myelopathy,2020 - Secondary publication.J Orthop Sci.2023;28(1):1-45.Youssef JA, Heiner AD, Montgomery JR, et al. Outcomes of posterior cervical fusion and decompression: a systematic review and meta-analysis.Spine J.2019;19(10):1714-1729.Mahmoud A, Shanmuganathan K, Montgomery A. Surgical Management of Hangman's Fracture: A Systematic Review.Int J Spine Surg.2023.Lee DY, Park YJ, Song MG, Kim KT, Kim DH. Comparison of anterior-only versus combined anterior and posterior fusion for unstable subaxial cervical injuries: a meta-analysis of biomechanical and clinical studies.Eur Spine J.2021;30(6):1460-1473.Yang JS, Liu P, Liu TJ, et al. When is the circumferential stabilization necessary for subaxial cervical fracture dislocations? The posterior ligament-bone injury classification and severity score: a novel treatment algorithm.Eur Spine J.2021;30(2):524-533.Madan A, Thakur M, Sud S, Jain V, Singh Thakur RP, Negi V. Subaxial Cervical Spine Injuries: Outcomes after Anterior Corpectomy and Instrumentation.Asian J Neurosurg.2019;14(3):843-847.Zheng HL, Li B, Song SK, Chen PB, Jiang LS, Jiang SD. Anterior cervical discectomy and fusion to treat cervical instability with vertigo and dizziness: A single center, retrospective, observational study.Front Surg.2022;9:1047504.
Proposed LCD - Cervical Fusion (DL39762)
Yang H, Wang H, Zhang B, Sun Y, Wang L, Lu X. Cervical spine fracture-dislocation in patients with ankylosing spondylitis and severe thoracic kyphosis: Application of halo vest before and during surgical management.Clin Neurol Neurosurg.2021;207:106744.Wang L, Wang H, Wang C, Zhang B, Yang H, Lu X. Comparative study of halo-vest reduction and skull traction reduction in the treatment of cervical fracture dislocation in patients with ankylosing spondylitis.Front Surg.2023;10:1129809.Skeppholm M, Svedmark P, Noz ME, Maguire GQ, Jr., Olivecrona H, Olerud C. Evaluation of mobility and stability in the Discover artificial disc: an in vivo motion study using high-accuracy 3D CT data.J Neurosurg Spine.2015;23(3):383-389.Rustagi T, Mashaly H, Mendel E. Posterior occiput-cervical fixation for metastasis to upper cervical spine.J Craniovertebr Junction Spine.2019;10(2):119-126.Luksanapruksa P, Millhouse PW, Carlson V, Ariyawatkul T, Heller J, Kepler CK. Comparison of Surgical Outcomes of the Posterior and Combined Approaches for Repair of Cervical Fractures in Ankylosing Spondylitis.Asian Spine J.2019;13(3):432-440.Li Z, Li F, Hou S, et al. Anterior discectomy/corpectomy and fusion with internal fixation for the treatment of unstable hangman's fractures: a retrospective study of 38 cases.J Neurosurg Spine.2015;22(4):387-393.Lee JS, Son DW, Lee SH, Ki SS, Lee SW, Song GS. Comparative Analysis of Surgical Outcomes of C1-2 Fusion Spine Surgery between Intraoperative Computed Tomography Image Based Navigation-Guided Operation and Fluoroscopy-Guided Operation.J Korean Neurosurg Soc.2020;63(2):237-247.
Proposed LCD - Cervical Fusion (DL39762)
Lang S, Neumann C, Fiedler L, Alt V, Loibl M, Kerschbaum M. Does Dynamic Anterior Plate Fixation Provide Adequate Stability for Traumatic Subaxial Cervical Spine Fractures at Mid-Term Follow-Up?J Clin Med.2021;10(6).Kong W, Yang X, Li Z, Hu B, Song Y. Analysis of the Cervical Sagittal Alignment in Patients with Unstable Hangman Fracture Under C2 approximately 3 Anterior Discectomy and Fusion.World Neurosurg.2020;137:e1-e8.Kim HS, Cloney MB, Koski TR, Smith ZA, Dahdaleh NS. Management of Isolated Atlas Fractures: A Retrospective Study of 65 Patients.World Neurosurg.2018;111:e316-e322.Bakhsheshian J, Sizdahkhani S, Ohiorhenuan I, Buchanan IA, Strickland B, Pham MH. Transpedicular lag screw placement in traumatic cervical spondylolisthesis: Case report and systematic review of the literature.J Clin Neurosci.2019;63:256-262.Jin C, Xie N, Ren Y, et al. How Does Cervical Sagittal Balance Change After Hangman Fracture Treated with Anterior or Posterior Approach Surgery?World Neurosurg.2020;138:e767-e777.Garrido BJ, Myo GK, Sasso RC. Rigid versus nonrigid occipitocervical fusion: a clinical comparison of short-term outcomes.J Spinal Disord Tech.2011;24(1):20-23.Dagtekin A, Avci E, Hamzaoglu V, et al. Management of occipitocervical junction and upper cervical trauma.J Craniovertebr Junction Spine.2018;9(3):148-155.Clark S, Nash A, Shasti M, et al. Mortality Rates After Posterior C1-2 Fusion for Displaced Type II Odontoid Fractures in Octogenarians.Spine (Phila Pa 1976).2018;43(18):E1077-E1081.
Proposed LCD - Cervical Fusion (DL39762)
Candura D, Perna A, Velluto C, et al. Conservative management of Anderson Type II odontoid fractures in octogenarians: is radiological union what we are searching for?Eur Rev Med Pharmacol Sci.2022;26(1 Suppl):33-42.Aldrian S, Erhart J, Schuster R, et al. Surgical vs nonoperative treatment of Hadley type IIA odontoid fractures.Neurosurgery.2012;70(3):676-682; discussion 682-673.Ghogawala Z, Terrin N, Dunbar MR, et al. Effect of ventral vs dorsal spinal surgery on patient-reported physical functioning in patients with cervical spondylotic myelopathy: a randomized clinical trial.Jama.2021;325(10):942-951.de Dios Perez E. Degenerative cervical myelopathy: Surgical treatment, imaging evaluation, and outcome. 2023.Sattari SA, Ghanavatian M, Feghali J, et al. Anterior cervical discectomy and fusion versus posterior decompression in patients with degenerative cervical myelopathy: a systematic review and meta-analysis.J Neurosurg Spine.2023:1-13.Selph SS SA, Jungbauer RM, Brodt E, Blazina I, Philipp TC, Mauer KM, Dettori J, Atchison C, Riopelle D, Stabler-Morris S, Fu R, Yu Y, Chou R. . Cervical Degenerative Disease Treatment: A Systematic Review. Comparative Effectiveness Review No. 266. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 75Q80120D00006.). AHRQ Publication No. 24-EHC001.Rockville, MD: Agency for Healthcare Research and Quality;.https://effectivehealthcare.ahrq.gov/products/cervical-degenerative-disease/research. Accessed11/28/23.