evekhm/cms_iom_500 huggingface dataset:
Proposed LCD - Facet Joint Interventions for Pain Management (DL38801)
Neuropathic pain-the pain which is caused by a lesion or disease of the somatosensory nerves.Neurogenic claudication-intermittent leg pain from impingement of the nerves emanating from the spinal cord (also called pseuduoclaudication)New Onset of Spinal Pain-The new onset of the spinal pain must be materially and significantly different in location, type, duration and character from the previously treated spine pain.Non-invasive conservative management- The use of nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, physical therapy, acupuncture (applies to only chronic low back pain), or spinal manipulation. This management should include the application a biopsychosocial treatment techniques.Non-Radicular Back Pain-The radiating non-neuropathic pain which is not causally related to a spinal nerve root irritation and does not produce reproducible neuropathic symptoms in an objective dermatomal pattern.Peripheral neuropathic pain-Pain, which is causally related to a lesion or disease of the peripheral somatosensory nerves.Radicular Back Pain-The radiating neuropathic pain causally related to the spinal nerve root irritation which extends into the distal distribution, typically the lower extremity, producing neuropathic pain in a dermatomal patternRadiculopathy-Radiating neuropathic pain causally related to the spinal nerve root irritation, which extends distally producing neuropathic pain in a dermatomal pattern.Region-The segments of the back involved will be defined in this policy as two regions:
Proposed LCD - Facet Joint Interventions for Pain Management (DL38801)
Cervical/Thoracic region= C1-C7/T1-T12Lumbar/Sacral region= L1-L5/S1-S5Session-A time period, which includes all procedures (i.e., medial branch blocks (MBB), intraarticular injections (IA), facet cyst ruptures, and RFA ablations) performed during one day.Subacute Pain-The temporal definition of pain occurring during the 4-12-week time period.Transforaminal epidural steroid injection (TFESI)-An epidural injection performed via a paramedian approach to enter the epidural space by placing the needle in the posterior-superior quadrant of the intervertebral foramen (neuroforamen) to inject near the dorsal root ganglion and exiting spinal nerve root (previously known as a selective nerve root block).Zygapophysial joint or z-joint-see Facet joint
Proposed LCD - Facet Joint Interventions for Pain Management (DL38801)
History/Background and/or General InformationThe spine is the most common source of chronic pain. Chronic axial spinal pain is one of the major causes of disability and accounts for a substantial US health burden. Chronic spine pain poses a peculiar diagnostic and therapeutic challenge due to multiple pain sources, overlapping clinical features, and nonspecific radiological findings.The facet joints can cause axial spinal pain and referred pain in the extremities. The pathology of the pain source is due to facet joints being richly innervated by the nerve fibers from the medial branch of the dorsal ramus of spinal nerves. Each facet has a dual nerve supply. One exception is at the C2C3 zygapophysial joint, which has a singular nerve supply from the third occipital nerve (the superficial medial branch of C3 dorsal ramus).1Facet joint interventions may be used in pain management for chronic cervical/thoracic and back pain arising from the paravertebral facet joints. The facet block procedure is an injection of a local anesthetic, with or without a steroid medication, either into the facet joint (intra-articular) or outside the joint space around the nerve supply to the joint (the medial branch nerve) known as medial branch block (MBB). Imaging guidance (fluoroscopy or CT per code descriptor) is used to assure accurate placement of the needle for the injection. Paravertebral facet joint denervation is a therapeutic intervention used to provide both long-term pain relief and reduce the likelihood of recurrence of chronic cervical/thoracic or back pain confirmed as originating in the facet joints medial branch nerve.1
Proposed LCD - Facet Joint Interventions for Pain Management (DL38801)
There are various methods that may be used in performing facet joint denervation. Percutaneous radiofrequency ablation (RFA) is a minimally invasive procedure done with imaging guidance (fluoroscopy or CT per code descriptor) and involves using energy in the radiofrequency range to cause necrosis of specific nerves (medial branches of the dorsal rami), preventing the neural transmission of pain. Conventional radiofrequency ablation (non- pulsed or continuous) applies thermal energy of typically 80 to 85 degrees Celsius. The terms radiofrequency ablation (RFA) and radiofrequency neurotomy are used interchangeably. Both terms refer to a procedure that destroys the functionality of the nerve using radiofrequency energy. Non-thermal methods of denervation include chemical (chemodenervation), low-grade thermal energy (less than 80 degrees Celsius), pulsed RFA, laser neurolysis, and cryoablation.1Throughout this document, societal recommendations with the grading of evidence are referenced. There are multiple systems to grade or rank the quality of medical evidence and develop evidence-based recommendations. Not all grading systems are equivalent, so while there are typically similarities in the grades or recommendations from various grading systems, they must be considered independent of the other. The references in this document refer to the following grading systems.
Proposed LCD - Facet Joint Interventions for Pain Management (DL38801)
GRADE Guidelines used in some systematic reviews, the basis for NASS recommendations aligns with GRADE.A Modified approach to the grading of evidence2and development of interventional pain management specific instrument3used in ASIPP Guidelines and some systematic reviews.US Preventive Services Task Force grading of evidence guidelines used by 2020 Consensus Guidelines by Cohen et al.4Levels of Evidence for Primary Research Question and Grades of Recommendation for Summaries or Review of Studies adopted by North American Spine Society (NASS).5A Multi-MAC Subject Matter Expert (SME) Panel on Facet Joint and Medial Nerve Branch Procedures meeting on was held on 5/28/2020.General InformationAssociated InformationPlease refer to the Local Coverage Article: Billing and Coding: Facet Joint Interventions for Pain Management (DA58403) for documentation requirements that apply to the reasonable and necessary provisions outlined in this LCD.Sources of InformationN/ABibliography
Proposed LCD - Facet Joint Interventions for Pain Management (DL38801)
Anesthesiologists ASo. Statement on Anesthetic Care During Interventional Pain Procedures for Adults. https://www.asahq.org/standards-and-practice-parameters/statement-on-anesthetic-care-during-interventional-pain-procedures-for-adults. Updated October 13, 2021. Accessed 9/26/23.Manchikanti L AS, Atluri S, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain physician. 2013;16:S49-283.Manchikanti L, Falco FJ, Benyamin RM, Kaye AD, Boswell MV, Hirsch JA. A modified approach to grading of evidence. J Pain Physician. 2014;17(3):E319-E325.Manchikanti L, Hirsch J, Cohen S, et al. Assessment of methodologic quality of randomized trials of interventional techniques: Development of an interventional pain management specific instrument. J Pain Physician. 2014;17:E263-E290.Cohen SP, Bhaskar A, Bhatia A, et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a Multispecialty, International Working group. Regional Anesthesia Pain Medicine. 2020;45(6):424-467.(NASS) NASS. Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care: Diagnosis & Treatment of Low Back Pain. https://www.spine.org/Portals/0/assets/downloads/ResearchClinicalCare/Guidelines/LowBackPain.pdf. Published 2020. Accessed 04/13/2020, 2020.Boswell MV, Manchikanti L, Kaye AD, et al. A Best-Evidence Systematic Appraisal of the Diagnostic Accuracy and Utility of Facet (Zygapophysial) Joint Injections in Chronic Spinal Pain. Pain Physician. 2015;18(4):E497-533.
Proposed LCD - Facet Joint Interventions for Pain Management (DL38801)
Manchikanti L, Kaye A, Soin A, et al. Comprehensive Evidence-Based Guidelines for Facet Joint Interventions in the Management of Chronic Spinal Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines Facet Joint Interventions 2020 Guidelines. J Pain Physician. 2020;23(3S):S1-S127.Steven Cohen SH, Yevgeny Semenov, Paul Pasquina, Ronald White, Elias Veizi, Julie Huang, Connie Kurihara, Zirong Zhao, Kevin Guthmiller, Scott Griffith, Aubrey Verdun, David Giampetro, Yakov Vorobeychik. Epidural steroid injections, conservative treatment, or combination treatment for cervical radicular pain: A multicenter, randomized, comparative-effectiveness study. Anesthesiology. 2014;121:10451055.Skelly AC, Chou R, Dettori JR, et al. Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Apr. 2020.Society NAS. Facet Joint Interventions | NASS Coverage Policy Recommendations. NASS Coverage Committee. 2017. www.spine.org.Authority GMC. Greater Manchester EUR Policy Statement on: Facet Joint Injections for Neck and Back Pain. GM Ref: GM070 Web site. http://northwestcsu.nhs.uk/BrickwallResource/GetResource/d5f134e0-aab1-4be3-9475-3f973f126423. Published 2018. Updated 25 January 2019. Accessed 06/11/2020.Deyo RA. Biopsychosocial Care for Chronic Back Pain. British Medical Journal Publishing Group. 2015;18(h538).Birkenmaier C, Veihelmann A, Trouillier HH, Hausdorf J, von Schulze Pellengahr C. Medial Branch Blocks Versus Pericapsular Blocks in Selecting Patients for Percutaneous Cryodenervation of Lumbar Facet Joints. Reg Anesth Pain Med. 2007;32(1):27-33.
Proposed LCD - Facet Joint Interventions for Pain Management (DL38801)
Cohen SP, Doshi TL, Constantinescu OC, et al. Effectiveness of Lumbar Facet Joint Blocks and Predictive Value before Radiofrequency Denervation: The Facet Treatment Study (FACTS), a Randomized, Controlled Clinical Trial. Anesthesiology. 2018;129(3):517-535.Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. The false-positive rate of uncontrolled diagnostic blocks of the lumbar zygapophysial joints. Pain. 1994;58(2):195-200.Yamashiro K, Arimura T, Iwaki R, Jensen MP, Kubo C, Hosoi M. A multidimensional measure of pain interference: reliability and validity of the pain disability assessment scale. Clin J Pain. 2011;27(4):338-343.Smeets R, Koke A, Lin CW, Ferreira M, Demoulin C. Measures of Function in Low Back Pain/Disorders: Low Back Pain Rating Scale (LBPRS), Oswestry Disability Index (ODI), Progressive Isoinertial Lifting Evaluation (PILE), Quebec Back Pain Disability Scale (QBPDS), and Roland-Morris Disability Questionnaire (RDQ). Arthritis Care & Research. 2011;63:S158-173.Fritz JM, Irrgang JJ. A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. Phys Ther. 2001;81(2):776-788.Chiarotto A, Maxwell LJ, Terwee CB, Wells GA, Tugwell P, Ostelo RW. Roland-Morris Disability Questionnaire and Oswestry Disability Index: Which Has Better Measurement Properties for Measuring Physical Functioning in Nonspecific Low Back Pain? Systematic Review and Meta-Analysis. Phys Ther. 2016;96(10):1620-1637.Koc M, Bayar B, Bayar K. A Comparison of Back Pain Functional Scale With Roland Morris Disability Questionnaire, Oswestry Disability Index, and Short Form 36-Health Survey. Spine. 2018;43(12):877-882.
Proposed LCD - Facet Joint Interventions for Pain Management (DL38801)
Stekas ND, Johnson B, Jevotovsky D, et al. PROMIS is superior to established outcome measures in capturing disability resulting from sagittal malalignment in patients with back pain. Spine Deform. 2020;8(3):499-505.Bogduk N. On the Rational Use of Diagnostic Blocks for Spinal Pain. Neurosurgery Quarterly. 2009;19(2):88-100.Derby R, Melnik I, Lee J-E, Lee S-H. Correlation of lumbar medial branch neurotomy results with diagnostic medial branch block cutoff values to optimize therapeutic outcome. J Pain Medicine. 2012;13(12):1533-1546Derby R MI, Choi J, Lee JE. Indications for repeat diagnostic medial branch nerve blocks following a failed first medial branch nerve block. Pain Physician. 2013;16:479-488.Manchikanti L, Kaye AD, Boswell MV, et al. A Systematic Review and Best Evidence Synthesis of the Effectiveness of Therapeutic Facet Joint Interventions in Managing Chronic Spinal Pain. Pain Physician. 2015;18(4):E535-582.Engel A RG, King W, Kennedy DJ, on behalf of the Standards Division of the International Spine Intervention Society. The Effectiveness and Risks of Fluoroscopically-Guided Cervical Medial Branch Thermal Radiofrequency Neurotomy: A Systematic Review with Comprehensive Analysis of the Published Data. J Pain Medicine. 2016;17(4):658-669.Engel A KW, Schneider BJ, Duszynski B, Bogduk N. The Effectiveness of Cervical Medial Branch Thermal Radiofrequency Neurotomy Stratified by Selection Criteria: A Systematic Review of the Literature. Pain Med. 2020.Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. J New England Journal of Medicine. 1996;335(23):1721-1726.
Proposed LCD - Facet Joint Interventions for Pain Management (DL38801)
Nath S, Nath CA, Pettersson K. Percutaneous lumbar zygapophysial (facet) joint neurotomy using radiofrequency current, in the management of chronic low back pain: a randomized double-blind trial. J Spine. 2008;33(12):1291-1297.Cohen SP, Williams KA, Kurihara C, et al. Multicenter, Randomized, Comparative Cost-effectiveness Study Comparing 0, 1, and 2 Diagnostic Medial Branch (Facet Joint Nerve) Block Treatment Paradigms before Lumbar Facet Radiofrequency Denervation. J Anesthesiology. 2010;113(2):395-405.Lilius G, Laasonen E, Myllynen P, Harilainen A, Gronlund G. Lumbar facet joint syndrome. A randomised clinical trial. The Journal of bone joint surgery British volume. 1989;71-B(4):681-684.Carette S, Marcoux S, Truchon R, et al. A controlled trial of corticosteroid injections into facet joints for chronic low back pain. J New England Journal of Medicine. 1991;325(14):1002-1007.Barnsley L, Lord SM, Wallis BJ, Bogduk N. Lack of Effect of Intraarticular Corticosteroids for Chronic Pain in the Cervical Zygapophyseal Joints. N Engl J Med. 1994;330(15):1047-1050.Kennedy DJ, Fraiser R, Zheng P, et al. Intra-articular Steroids vs Saline for Lumbar Z-Joint Pain: A Prospective, Randomized, Double-Blind Placebo-Controlled Trial. Pain Med. 2019;20(2):246-251.Schneider BJ, Doan L, Maes MK, et al. Systematic Review of the Effectiveness of Lumbar Medial Branch Thermal Radiofrequency Neurotomy, Stratified for Diagnostic Methods and Procedural Technique. J Pain Medicine. 2020;21(6):1122-1141.
Proposed LCD - Facet Joint Interventions for Pain Management (DL38801)
Vekaria R, Bhatt R, Ellard DR, Henschke N, Underwood M, Sandhu H. Intra-articular facet joint injections for low back pain: a systematic review. Eur Spine J. 2016;25(4):1266-1281.NICE G. Low back pain and sciatric in over 16s: assessment and management wwwniceorguk/guidance/ng59. 2016.Chou R, Hashimoto R, Friedly J, et al. Pain management injection therapies for low back pain: Technology Assessment. Agency for Healthcare Research and Quality (AHRQ) https://www.ncbi.nlm.nih.gov/books/NBK285206/. Published 2015. Accessed.Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical Interventional Therapies for Low Back Pain: A Review of the Evidence for an American Pain Society Clinical Practice Guideline. Spine. 2009;34(10):1078-1093.Management ASoATFoCP, Medicine ASoRAaP. Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology 2010;112(4):810-833.Watters WC, Resnick DK, Eck JC, et al. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 13: injection therapies, low-back pain, and lumbar fusion. Journal of Neurosurgery: Spine. 2014;21(1):79-90.Maas ET, Ostelo RW, Niemisto L, et al. Radiofrequency denervation for chronic low back pain. J Cochrane Database of Systematic Reviews. 2015(10).Juch J, Maas E, Ostelo R. Effect of radiofrequency denervation on pain intensity among patients with chronic low back pain: the Mint randomized clinical trials (vol 318, pg 68, 2017). JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. 2017;318(12):1188-1188.
Proposed LCD - Facet Joint Interventions for Pain Management (DL38801)
Leggett LE, Soril LJ, Lorenzetti DL, et al. Radiofrequency ablation for chronic low back pain: a systematic review of randomized controlled trials. J Pain Research Management. 2014;19.Lee CH, Chung CK, Kim CH. The efficacy of conventional radiofrequency denervation in patients with chronic low back pain originating from the facet joints: a meta-analysis of randomized controlled trials. Spine J. 2017;17(11):1770-1780.Bernstein IA, Malik Q, Carville S, Ward S. Low back pain and sciatica: summary of NICE guidance. J Bmj. 2017;356(i6748).Atluri S, Datta S, Falco FJ, Lee M. Systematic Review of Diagnostic Utility and Therapeutic Effectiveness of Thoracic Facet Joint Interventions. Pain Physician. 2008;11(5):611-629.Services UDoHaH. Medicare Payments for Facet Joint Injection Services. 2008.Feigl GC DM, Kastner M, et al. Thermocoagulation of the medial branch of the dorsal branch of the Lumbal spinal nerve: Flouroscopy versus CT. Pain Med. 2017;18:3640.Shuang F, Hou S-X, Zhu J-L, Ren D-F, Cao Z, Tang J-G. Percutaneous Resolution of Lumbar Facet Joint Cysts as an Alternative Treatment to Surgery: A Meta-Analysis. PLoS One. 2014;9(11):e111695.Brummett CM, Goesling J, Tsodikov A, et al. Prevalence of the fibromyalgia phenotype in patients with spine pain presenting to a tertiary care pain clinic and the potential treatment implications. Arthritis Rheumatism2013;65(12):3285-3292.Cohen SP, Bajwa ZH, Kraemer JJ, et al. Factors predicting success and failure for cervical facet radiofrequency denervation: a multi-center analysis. Regional anesthesia and pain medicine. 2007;32(6):495-503.
Proposed LCD - Facet Joint Interventions for Pain Management (DL38801)
Cook DJ, Yeager MS, Oh MY, Cheng BC. Lumbar Intrafacet Bone Dowel Fixation. J Neurosurgery. 2015;76(4):470-478.Li Z-Z, Hou S-X, Shang W-L, Song K-R, Wu W-WJCn, neurosurgery. Evaluation of endoscopic dorsal ramus rhizotomy in managing facetogenic chronic low back pain. 2014;126:11-17.Abejn D, Ortego R, Sols R, Alaoui N, del Saz J, del Pozo C. Trans-facet-joint approach to pulsed radiofrequency ablation of the L5 dorsal root ganglion in a patient with degenerative spondylosis and scoliosis. Pain practice : the official journal of World Institute of Pain. 2008;8(3):202-205.Hashemi M, Hashemian M, Mohajerani SA, Sharifi G. Effect of pulsed radiofrequency in treatment of facet-joint origin back pain in patients with degenerative spondylolisthesis. Eur Spine J. 2014;23(9):1927-1932.Iwatsuki K, Yoshimine T, Awazu K. Alternative denervation using laser irradiation in lumbar facet syndrome. Lasers in Surgery Medicine: The Official Journal of the American Society for Laser Medicine 2007;39(3):225-229.Joo YC, Park JY, Kim KH. Comparison of alcohol ablation with repeated thermal radiofrequency ablation in medial branch neurotomy for the treatment of recurrent thoracolumbar facet joint pain. J Anesth. 2013;27(3):390-395.Kroll HR, Kim D, Danic MJ, Sankey SS, Gariwala M, Brown M. A randomized, double-blind, prospective study comparing the efficacy of continuous versus pulsed radiofrequency in the treatment of lumbar facet syndrome. Journal of clinical anesthesia. 2008;20(7):534-537.
Proposed LCD - Facet Joint Interventions for Pain Management (DL38801)
Anesthesiologists ASo. Statement on Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia. https://www.asahq.org/standards-and-practice-parameters/statement-on-continuum-of-depth-of-sedation-definition-of-general-anesthesia-and-levels-of-sedation-analgesia. Published 2019. Updated 10/23/2019. Accessed 9/28/2023.Kim DK. Nonoperating room anaesthesia for elderly patients. Current Opinion in Anesthesiology. 2020;33(4):589-593.Overdyk FJ, Dowling O, Marino J, et al. Association of opioids and sedatives with increased risk of in-hospital cardiopulmonary arrest from an administrative database. PloS one. 2016;11(2):e0150214.Byron Schneider; Zachary McCormick David OBrien J, Michael Bunch; and Clark C. Smith on behalf of the Spine Intervention Societys Patient Safety Committee. Conscious Sedation. Spine Intervention Society. Published 2018. Accessed9/26/23.Cohen SP, Hameed H, Kurihara C, et al. The effect of sedation on the accuracy and treatment outcomes for diagnostic injections: a randomized, controlled, crossover study. Pain Medicine. 2014;15(4):588-602.Diehn FE, Geske JR, Amrami KK, et al. An audit of transforaminal epidural steroid injections without sedation: Low patient dissatisfaction and low vasovagal rates. Pain Medicine. 2013;14(7):994-998.Manchikanti L, Kosanovic R, Pampati V, et al. Equivalent outcomes of lumbar therapeutic facet joint nerve blocks and radiofrequency neurotomy: comparative evaluation of clinical outcomes and cost utility. Pain physician. 2022;25(2):179.Manchikanti L, Kosanovic R, Pampati V, Sanapati MR, Hirsch JA. Outcomes of cervical therapeutic medial branch blocks and radiofrequency neurotomy: clinical outcomes and cost utility are equivalent. Pain Physician. 2022;25(1):35.
Proposed LCD - Facet Joint Interventions for Pain Management (DL38801)
Baroncini A, Maffulli N, Eschweiler J, Knobe M, Tingart M, Migliorini F. Management of facet joints osteoarthritis associated with chronic low back pain: A systematic review. The Surgeon. 2021;19(6):e512-e518.Do KH, Ahn SH, Cho YW, Chang MC. Comparison of intra-articular lumbar facet joint pulsed radiofrequency and intra-articular lumbar facet joint corticosteroid injection for management of lumbar facet joint pain: A randomized controlled trial. Medicine. 2017;96(13).Lee DG, Ahn SH, Cho YW, Do KH, Kwak SG, Chang MC. Comparison of Intra-articular Thoracic Facet Joint Steroid Injection and Thoracic Medial Branch Block for the Management of Thoracic Facet Joint Pain. Spine. 2018;43(2):76-80.Rocha IDd, Cristante AF, Marcon RM, Oliveira RP, Letaif OB, Barros Filho TEPd. Controlled medial branch anesthetic block in the diagnosis of chronic lumbar facet joint pain: the value of a three-month follow-up. Clinics. 2014;69:529-534.General. OoI. Medicare Payments for Facet Joint Injection Services. . U.S. Department of Health and Human Services.Web site. https://oig.hhs.gov/oei/reports/oei-05-07-00200.pdf. Accessed10/31/23.2017 Scientific Session of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Houston, Texas, USA, 22-25 March 2017 : Video Presentations. Surg Endosc. 2017;31(Suppl 1):68-107.Campos WK LM, Sarda J, et al. . Predictors of Pain Recurrence After Lumbar Facet Joint Injections. Frontiers in neuroscience [Front Neurosci]. 2019;13:958.