evekhm/cms_iom_500 huggingface dataset:
Proposed LCD - Facet Joint Interventions for Pain Management (DL38803)
Neuropathic pain-he 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 (DL38803)
Cervical/Thoracic region= C1-C7/T1-T12Lumbar/Sacral region= L1-L5/S1-S5
Proposed LCD - Facet Joint Interventions for Pain Management (DL38803)
Session- 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 jointHistory/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).1
Proposed LCD - Facet Joint Interventions for Pain Management (DL38803)
Facet 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.1There 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 (DL38803)
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 (DA58405) 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 (DL38803)
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Proposed LCD - Facet Joint Interventions for Pain Management (DL38803)
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Proposed LCD - Facet Joint Interventions for Pain Management (DL38803)
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Proposed LCD - Facet Joint Interventions for Pain Management (DL38803)
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Proposed LCD - Facet Joint Interventions for Pain Management (DL38803)
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Proposed LCD - Facet Joint Interventions for Pain Management (DL38803)
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Proposed LCD - Facet Joint Interventions for Pain Management (DL38803)
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Proposed LCD - Facet Joint Interventions for Pain Management (DL38803)
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Proposed LCD - Facet Joint Interventions for Pain Management (DL38803)
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Proposed LCD - Facet Joint Interventions for Pain Management (DL38803)
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