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?