When considering adding spine to an ASC, Nick Shamie, MD, of Santa Monica-based UCLA Spine Center, recommends surgeons check coverage for specific procedures. Payers may not cover certain procedures a surgeon wishes to perform, in which case the cash prices must be affordable for patients.
"I think the one issue with these novel technologies is coverage, because some insurance companies won't cover," says Dr. Shamie.
He recommends a few novel procedures that fit well within the outpatient setting. "There are some novel techniques that I think are going to be helpful because of vey little risk of injury to structures," says Dr. Shamie.
For cervical stenosis procedures, Dr. Shamie places a spacer between facet joints to elevate the bones and free up the nerve. "You don't have to make any incision that you have to look through, because it's done percutaneously," he says.
Dr. Shamie utilizes the following two technologies in the outpatient setting:
- VertiFlex's Superion Interspinous Spacer, which is an indirect decompression spinal implant system for lumbar spinal stenosis treatment. Dr. Shamie places the spacer between the bones to jack up the height. Surgeons have implanted more than 2,000 of these devices in patients around the globe.
- Paradigm Spine's coflex, which is the first motion preserving minimally invasive treatment for spinal stenosis post decompression. Dr. Shamie places the coflex between the lamina to help maintain the foramina.
Of the 650,000 to 700,000 spine cases performed in the U.S. annually, about 280,000 to 300,000 are done on an outpatient basis. Lumbar decompression and anterior cervical fusions, for example, are most commonly performed in the outpatient setting.
In 2015, CMS added nine new spine procedure codes on the ASC payable list:
- Neck spine fusion & removable c2 (22551)
- Neck spine fusion (22554)
- Lumbar spine fusion (22612)
- Neck spine disc surgery (63020)
- Low back disc surgery (63030)
- Laminectomy single lumbar (63042)
- Removal of spinal lamina (63045)
- Removal of spinal lamina (63047)
- Decompression spinal cord (63056)
"The smaller the surgery, the more appropriate it is in an ASC," says Dr. Shamie. "The bigger the surgery, the riskier it gets." All ASCs are required to have transfer agreements with a hospital.
"Planning is very important," Dr. Shamie says. "A quote from Coach John Wooden comes to mind: 'failing to prepare, is preparing to fail.'"
Although these novel techniques will continue to gain traction in the outpatient spine environment, Dr. Shamie does not believe they will replace the traditional techniques.
"Those old techniques are tried and true and some of these novel techniques have limitations based on who are appropriate patients," says Dr. Shamie.