Oblique Lateral Interbody Fusion - Medtronic

1 REIMBURSEMENT. GUIDE. Oblique Lateral Interbody Fusion The Oblique Lateral Interbody Fusion (OLIF) procedure allows for minimally invasive retroperitoneal access to the lumbar spine for surgeons who want to address degenerative pathologies. PHYSICIAN. CODING/REIMBURSEMENT. Physicians use Current Procedural Terminology (CPT ) codes Industrial or workrelated injury cases are usually reimbursed to report all of their services. These codes are uniformly according to the official fee schedule for each state. accepted by all payers. medicare and most indemnity insurers Use of CPT codes is governed by various coding guidelines use a fee schedule to pay physicians for their professional published by the AMA and other major sources such as services, assigning a payment amount to each CPT code.

2 Physician specialty societies. In addition, the National Correct Under medicare 's RBRVS methodology for physician payment, Coding Initiative (NCCI), a set of CPT coding edits created and each CPT code is assigned a point value, known as the Relative maintained by CMS, has become a national standard. Value Unit (RVU), which is then multiplied by a conversion factor to determine the physician payment. Many other The following CPT code may be appropriate for the payers use medicare 's RBRVS fee schedule or a variation on it. performance of an OLIF: 2017 medicare CPT Code Description RVUs Payment*.

3 22558 Arthrodesis, anterior Interbody technique, including minimal discectomy $1, to prepare interspace (other than for decompression); lumbar *Check bundling edits before applying and submitting codes for payment Source: CY2017 medicare Physician Fee Schedule, Final Rule. Federal Register, November 15, 2016. No geographic adjustments. FACILITY. REIMBURSEMENT. Inpatient Reimbursement Hospital payment for inpatient services/procedures is usually based on diagnosis related groups (DRGs), case rates, per diem rates, or a line item payment methodology.

4 medicare uses the medicare severity -DRG (MS-DRG payment methodology to reimburse hospitals for inpatient services. Each inpatient stay is assigned to one payment group, based on the ICD-10-PCS. codes assigned to the major diagnoses and procedures. Each DRG has a flat payment rate which bundles the reimbursement for all services the patient received during the inpatient stay. Most insurers usually pay the hospital on a contractual basis ( , case rate or per diem rate) that has been negotiated between the hospital and insurance carrier.)

5 ICD-10-PCS Procedure Codes Hospitals use ICD-10-PC S procedure codes to report inpatient services. In ICD-10-PCS insertion of Interbody devices is included in the 6th character device value of the primary procedure code, and not coded separately. The following ICD-10-PCS. codes may be appropriate for the performance of a OLIF with an Interbody Fusion device: Code Description 0SG00A0 Fusion of Lumbar Vertebral Joint with Interbody Fusion Device, Anterior Approach, Anterior Column, Open Approach 0SG10A0 Fusion of 2 or more Lumbar Vertebral Joints with Interbody Fusion Device, Anterior Approach, Anterior Column, Open Approach 0SG00A0 Fusion of Lumbar Vertebral Joint with Interbody Fusion Device, Anterior Approach, Anterior Column, Open Approach Diagnosis-Related Groups (DRGs).

6 FY2017 medicare severity Diagnosis Related Group (MS-DRG) Assignment Relative MS-DRG Description* MDC Payment*. Weight*. 028 Spinal procedures with MCC 01 $33,058. 029 Spinal procedures with CC or spinal neurostimulator 01 $19,011. 030 Spinal procedures without CC/MCC 01 $11,334. 453 Combined anterior/posterior spinal Fusion with MCC 08 $64,673. 454 Combined anterior/posterior spinal Fusion with CC 08 $48,425. 455 Combined anterior/posterior spinal Fusion without CC/MCC 08 $37,845. 456 Spinal Fusion except cervical with spinal curvature/malignancy/ 08 $59,127.

7 Infection or extensive fusions with MCC. 457 Spinal Fusion except cervical with spinal curvature/malignancy/ 08 $42,052. infection or extensive fusions with CC. 458 Spinal Fusion except cervical with spinal curvature/malignancy/ 08 $31,835. infection or extensive fusions without CC/MCC. 459 Spinal Fusion except cervical with MCC 08 $39,076. 460 Spinal Fusion except cervical without MCC 08 $23,789. Under the MS-DRG system, cases may be assigned to a number of other MS-DRGs, based on individual patient diagnosis and presence or absence of additional surgical procedures performed.

8 Additional MS-DRGs include but are not limited to: MS-DRGs 907, 908, 909; MS-DRGs 957, 958, 959; MS-DRGs 981, 982, 983. *MCC Major Complication and/or Comorbidity. CC Complication and/or Comorbidity. Source: FY2017 medicare Hospital Inpatient Prospective Payment System, Final Rule. Federal Register, August 22, 2016. Assumes payment for a hospital with a wage index and geographic adjustment factor of and submitted quality data and is a meaningful EHR user. 2. Oblique Lateral Interbody Fusion . FACILITY REIMBURSEMENT. Outpatient Reimbursement Hospitals use the Healthcare Common Procedure Coding Many payers use medicare 's APC methodology or a similar System (HCPCS) to report outpatient services.

9 Under type of fee schedule to reimburse hospitals for outpatient medicare 's methodology for hospital outpatient payment, services. Other payers use a percent of charges mechanism, each HCPCS code is assigned to one Ambulatory Payment depending on their contract with the hospital. Classification (APC). Each APC has a relative weight which is medicare does not cover lumbar Interbody spinal fusions in multiplied by a conversion factor to determine the hospital the outpatient setting. However, commercial payers may payment. An APC and payment amount are assigned to each allow the procedure to be performed in this setting.

10 In these significant service. Although some services are bundled and cases, hospitals will want to contact the payer and review not separately payable, total payment to the hospital is the their payer contracts to ensure that they provide adequate sum of the APC amounts for the services provided during the payment for this procedure in the outpatient setting. outpatient encounter. CY '17. HCPCS Status Relative medicare Code Description APC Indicator Weight Payment 22558 rthrodesis, anterior Interbody technique, including minimal A C.