Payers have posed as obstacles for spine in ambulatory surgery centers, but the recent additions and proposals of ASC payable codes for spine procedures should ease up some of the difficulties surgery centers face.
In August, CMS proposed these eight new spine codes for the ASC payable list in 2017:
1. Autograft for spine surgery (20936) — (includes harvesting the graft); local (eg, ribs, spinous process or laminar fragments) obtained from the same incision (List separately in addition to code for primary procedure)
2. Autograft for spine surgery only (20937) — (includes harvesting the graft); morselized (through separate skin or fascial incision) (List separately in addition to code for primary procedure)
3. Autograft for spine surgery only (20938) — (includes harvesting the graft); structural biocortical or tricortical (through separate skin fascial incision)
4. Arthrodesis, anterior interbody (22552) — including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical C2, each additional interspace (List separately in addition to code for separate procedure)
5. Posterior non-segmental instrumentation (22840) — (eg, Harrington rod technique, pedicle screw fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation)
6. Posterior non-segmental instrumentation (22842) — (eg. Harrington rod technique, pedicle fixation across one interspace, atlantoaxial transarticular screw fixation, subliminar wiring at C1, facet screw fixation)
7. Anterior instrumentation; two to three vertebral segments (22845)
8. Application of intervertebral biomechanical device(s) (22851) — (eg, synthetic cage(s), methlmethacrylate) to vertebral defect or interspace (List separately in addition to code for primary procedure)
But, if approved, how will these new codes actually impact spine surgeons?
Richard Wohns, MD, JD, MBA, of Puyallup, Wash.-based NeoSpine, offers his take on the surge of spine into the outpatient setting.
"[There will be] increased opportunity for more surgeries to be performed in an outpatient center rather than in a hospital, for appropriate Medicare cases," Dr. Wohns says.
He has already seen the impact of the ASC payable spine codes added in 2015:
1. [Neck spine fuse & remov bel c2 (22551)]
2. Neck spine fusion (22554)
3. Lumbar spine fusion (22612)
4. Neck spine disc surgery (63020)
5. Low back disc surgery (63030)
6. Laminectomy single lumbar (63042)
7. Removal of spinal lamina (63045)
8. Removal of spinal lamina (63047)
9. Decompression spinal cord (63056)
Since the addition of these payable codes, NeoSpine has experienced a 12 percent increase in its outpatient spine surgery volume, tied to Medicare patients possessing the option of undergoing outpatient spine surgery in ASCs.
And Dr. Wohns believes this trend toward outpatient spine surgery will continue.
"More and more spine procedures are being performed outpatient and more and more spine procedures should be performed outpatient," he says. Patients undergoing outpatient spine surgery experience higher satisfaction rates and enhanced outcomes, he adds.
Dr. Wohns co-authored a recent study in Spine, which examined outpatient spine surgery in ambulatory surgery centers for predictive factors and clinical results. The study analyzed 54 consecutive patients treated with XLIF and 18 consecutive patients treated with MIS posterior fusion in an ASC. The researchers found no intraoperative complications and few postoperative complications for the XLIF or MIS posterior procedures. Additionally, no patients experienced transfers to inpatient facilities from the ASC.
"And there is lower cost related to outpatient spine surgeries compared to inpatient procedures," says Dr. Wohns. The study found outpatient surgery lowered costs of spine procedures: "In instances where it has been shown to be reproducible, spine surgery in an outpatient ambulatory surgery center can have a substantial impact on reining in medical costs and may result in a better experience for the patient."
Due to implant cost markups and operating room time in hospitals, ASCs can see a 60 percent cost savings over a hospital when performing the same spine surgery, according to the Society for Ambulatory Spine Surgery.
As healthcare dives deeper into a value-based world, outpatient spine surgery will likely continue gaining traction with the motto of higher quality and lower costs.