Coding for XLIF/ALIF is a straight forward code that has been established by NASS. NASS has been clear on how to code this procedure. The concern that surgeons are not being reimbursed has more to do with individual coding on a local level than on a national level. To NuVasive's knowledge, there have been no denials if the procedure is coded as an ALIF. It is NuVa's intention to have "thought leaders" or champion surgeons educate payors on what an XLIF approach entails.
As of this conference call , NuVa has had no conversations with the aforementioned payors. If anything, the confusion is being caused by the surgeons' themselves. The analysts were given an explanation as to how CMS establishes reimbursement based on Relative Value Units (RVU's). To date there are 8 Peer Review Articles with Comparative Outcomes available some time in 2010 and 2011.
Lukianov estimated that 30-35% of XLIF sales are covered by the three insurance companies mentioned. In closing it should make no difference to the payor whether the procedure is coded as an XLIF or ALIF. Interestingly enough non of the analysts asked whether there were any concern about post-op transient pain and whether this was contributing to the payors concerns. Well what would we expect from an analyst? Well it's back to the drawing board for those of you that have to compete with this procedural product. TSB wants to know what our readers think about this product?
i didnt hear what you did. i heard the beginning of another trans one. insurance cant undo fusion but they can pick off technologies that dont exactly fit current coding options. Mark my words that this will be put into a new code that will have less value than current fusion codes...hence surgeons will start leaving the technology....itll take 9 months to a year for it to happen
ReplyDeleteSounds like a T code in the near future... Cat III = experimental = no pay.
ReplyDeleteEven if a new XLIF T-code is implemented, some surgeons and/or the billing department would plead ignorance and continue to use the ALIF code.
ReplyDeleteI find it odd that a procdeure which has been performed for years (ant lateral approach),which has now been refined to be less morbid, is under such fire. If the technique described pulling back the psoas and a 15" flank incision, would this be an issue? A retro, trans psoas approach has been done for years (McAfee'98 and beyond). NuVasive has not invented a new technique with XLIF . . . it has simply provided a more elegant, safer, and reprodcible pathway to the spine to accomplish an anterior lumbar fusion. When NuVasive was a small upstart, no one seemed to care. Now, as the market becomes crowded, encumbents market share erodes, and companies like NuVasive deliver upon promises to the street and surgeons alike. . . many are up in arms. XLIF is a marketing name, and XILF is simply an anterior fusion as defined by NASS in 2006, and people who speak out against XLIF are often those who have never done a case, but are first inline to share how they would "improve the technique" . . . often for a consultant fee. Its these same people who love to be the contrarian at meetings to hear the sound of their own voice. BTW . . . the person posting and complaning about the cost of a one level XLIF needs to check their facts. At list price, no XLIF could ever cost the amount he/she suggested. If he/she wants to target an overpriced implant which has been abused . . . look no further than Infuse. It is its own BILLION dollar industry for MSD. What do you think the costs to hospitals have been from revisions due to ectopic bone growth, inflammation, wash outs, subsidence, etc.
ReplyDeleteMy Hats off to someone who knows what the heck they are talking about. Too many people trying to stir this issue without all their facts,
ReplyDeleteTo anonymous who classified his overpriced implant not as bad as MSD's overpriced implant........list the prices for the XLIF components by line item. If the previous entry about pricing for a one level XLIF was not correct, let us know better. What is the right price or ball park price for the XLIF Cage, Electrode Disposables, Retractor Disposables, Plate/Bolts, Formagraft or OsteoCel Plus? Don't change the topic and bring up InFuse issues. What do believe is the ball park pricing for a one level XLIF?
ReplyDeleteadd on redemption risk of notes and ip issues and 2010 is gonna look real bad
ReplyDelete