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Medical Coding News Archives

Medicare Considers Coverage for Lumbar Decompression

May 2, 2013:

Karen H. Kachur, RN, CPC, Clinical/Technical Editor

On April 5, 2013, the Centers for Medicare and Medicaid Services (CMS) opened a national coverage analysis (NCA) for percutaneous image-guided lumbar decompression for lumbar spinal stenosis.

Open and endoscopically assisted laminotomy/laminectomy procedures that require open and direct visualization are outside of the scope of this NCA and will not be reviewed as part of this analysis.

Percutaneous image-guided lumbar decompression is a minimally invasive laminotomy/laminectomy procedure (interlaminar approach) used to decompress the lumbar spine when the primary diagnosis is lumbar spinal stenosis. The procedure is performed under indirect imaging guidance such as fluoroscopy or CT, and an endoscope may or may not be used. This procedure is proposed as a treatment for symptomatic lumbar spine stenosis that is unresponsive to conservative therapy.

In lumbar spine stenosis, the area around the spinal cord and the spinal nerve roots becomes abnormally narrow. This results in back pain with numbness or leg weakness that worsens with standing or walking and is alleviated with sitting or leaning forward (neurogenic claudication). Caused by degenerative arthritis and changes related to aging, lumbar spine stenosis is the most common indication for back surgery in adults over the age of 65. Symptoms are relieved when the spinal cord or nerve roots are decompressed.

CMS initiated this NCA to thoroughly investigate all evidence to establish if percutaneous image-guided lumbar decompression is reasonable and necessary, and eligible for Medicare coverage. As part of the agency’s investigation, CMS is inviting public comments on the clinical evidence regarding the benefits derived from the procedure and is very interested in comments incorporating published clinical studies and other scientific information. The comment period ends on May 5, 2013, and the expected date of completion is January 3, 2014.


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