Neurosurgeons have one of the most difficult jobs in all of medicine. Spinal surgeries can have a profound effect on the patient for the rest of their lives, both good and bad. At Spinal Kinetics, we can to help reduce failed back surgeries by providing the surgeon with and accurate and reliable read out of the spines inter-segmental movement patterns. Now you can create a surgical care plan that addresses potential pre-existing spinal instability above and below the proposed fusion site.
Spinal Fusion Surgeries are most commonly utilized to address one of two situations as perfectly laid out in the language of the Blue Cross Blue Shield Policy for Lumbar Fusion Pre-Authorizations, and it states:
“To improve communication related to authorization for lumbar spinal surgery, we have separated the guideline into two general categories:”
- Surgery related to the treatment of sciatica or other nerve root impingements where primary intervention is related to removal of an offending herniated disk.
- Surgery related to mechanical and anatomical abnormalities for which spinal fusion may be appropriate treatment.
While category 1 is self explanatory, category 2 is most commonly reserved for spinal instabilities (abnormal spinal motion causing clinical spinal instability). Referring back to the same Blue Cross Blue Shield Policy it recites the following needs:
The minimal documentation necessary to accurately and expeditiously complete pre-authorization requests for spinal fusion are:
- Office notes, including history and physical
- Detailed documentation of extent and response to conservative therapy
- Radiology reports for MRI`s, CT`s, etc..
- Flexion-extension films for spinal fusion request based on instability
- Oswestry Disability Index or Roland-Morris Disability Questionnaire or results of SF-36 and psychological assessments (if indicated)
- Medical clearance reports (as indicated)
- Documentation of smoking abstinence (as indicated)
- Specific procedures with CPT/ICD-9 codes and disc levels indicated
At Spinal Kinetics we can provide you with the Biomechanical Mensuration Report that you need to both determine the best care plan for your patient as well as determine if that patient meets the pre-authorization Radiographic Mensuration Criteria now found in many pre-authorization guidelines.