Spine surgery and innovations are evolving, but some billing codes need to catch up to the current pace, Morgan Lorio, MD, said.
Dr. Lorio, co-president of the International Society for the Advancement of Spine Surgery, joined the “Becker’s Spine and Orthopedic Podcast” to discuss those codes and the areas of physician advocacy he’s prioritizing.
Note: This is an edited excerpt. Listen to the full conversation here.
Question: What are some of your top priorities when it comes to physician advocacy this year?
Dr. Morgan Lorio: Physician advocacy is more critical than ever, especially in such a rapidly evolving field. My biggest priorities are ensuring reimbursement keeps pace with innovation. We have the technology for motion preservation, biologics and disc regeneration. But if insurers don’t cover these advancements, patients don’t benefit. We have to protect physician autonomy. We must make sure that surgeons, not payers, are deciding the best treatments for their patients.
Finally, bringing spine surgery coding into the modern era is a big need. Many of the procedures we perform today aren’t reflected in current reimbursement models, and that needs to change. ISASS plays a big role in pushing for these reforms, and with our 25th anniversary we’re more committed than ever to ensuring the spine surgeons worldwide have the tools and policies in place to deliver the best care possible.
Q: Can you give me an example of a procedure that you would like to see have its codes modernized?
ML: Two areas come to mind. One is decompression with placement of inner spinous spacer, known by many as Coflex.
The code is now expanded to include other devices that are seeking FDA approval, but it remains undervalued. Because it was undervalued, the device flatlined relative to sales and because of it being bundled rightly or wrongly, it puts it at odds with codes that some entrenched societies don’t want touched, potentially in terms of reconsideration through the RUC process. As such, when this code is analyzed, it’s not shown in the best light, and the work is not appreciated. I think the newer products that are developing under this code descriptor, actually involve more time than Coflex, and hopefully we can get that re-assessed in the near future.
Another example would be the code for endoscopic lumbar spinal decompression, which was recognized to have an intensity that superseded almost everything in spine. And frankly, the current review process was such that it could not adequately be assessed, and CMS rightly made a decision that it was beyond the AMA and that each surgeon was going to have to negotiate a payment plan with each insurer.
That makes it kind of an untidy situation to manage, but it was at least better than the alternative. We need to have a plan in place that pays parity. If a procedure achieves the same goal, improves outcome and lessens cost, why can’t we reward the surgeon rather than torture him by literally paying him less and driving him away from providing that treatment? We try to provide patient centered care, and we’re currently prohibited from doing so with the current payment model.
