10 Vertebral augmentation provides a significant mortality benefit over nonsurgical management with a low number needed to treat (NNT). 11 Under-diagnosis and under-treatment may exacerbate morbidity and mortality. 10 Medicare claims data shows a 85% 10-year mortality following a VCF diagnosis. They may cause significant acute and chronic pain, leading to complications of impaired mobility (comparable to a hip fracture, pneumonia, loss of bone and muscle mass, incidental falls, deep venous thrombosis, depression, and isolation). VCFs constitute one-quarter of osteoporotic fractures, 6 often at the midthoracic (T7-T8) and thoracolumbar junction (T12-L1). Its primary impact, fractures (also called fragility or low-trauma fractures), occurs secondary to normal activity (e.g., bending, coughing, lifting, fall from a standing height), and eventually occurs in 50% of women and 20% of men. Osteoporosis (and low bone mass) affects 50% of people over 50 years of age, or over 50 million people in the United States. Vertebral augmentation and kyphoplasty for VCFs with intractable spinal pain not relieved with medical therapy will be covered for osteolytic vertebral metastatic disease or myeloma involving a vertebral body. Allergy to bone cement or opacification agents.Osteomyelitis, discitis or active systemic or surgical site infection.Current back pain is not primarily due to the identified acute or subacute VCF(s).Exclusion criteria 2,5,8-10 (Can have NONE of the following): All patients with VCF should be instructed to take part in an osteoporosis prevention/treatment program.Ģ.All patients presenting with VCF should be referred for evaluation of bone mineral density (BMD) and osteoporosis education for subsequent treatment as indicated.*Consider including pedicle periosteal infiltration 7 Severe impact of VCF on daily functioning (Roland Morris Disability Questionnaire (RDQ) >17).Acute ( 25% vertebral body height reduction.PVA (percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP)) is covered in patients with BOTH the following:ġ. Not endorsed by the AHA or any of its affiliates.Ĭoverage Indications, Limitations, and/or Medical Necessity Presented in the material do not necessarily represent the views of the AHA. Preparation of this material, or the analysis of information provided in the material. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness orĪccuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the Resale and/or to be used in any product or publication creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions Īnd/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is onlyĪuthorized with an express license from the American Hospital Association. Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. AHA copyrighted materials including the UB‐04 codes andĭescriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may beĬopied without the express written consent of the AHA. All rights reserved.Ĭopyright © 2023, the American Hospital Association, Chicago, Illinois. The AMA assumes no liability for data contained or not contained herein.Ĭurrent Dental Terminology © 2022 American Dental Association. The AMA does not directly or indirectly practice medicine or dispense medical services. Applicable FARS/HHSARS apply.įee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not AMA CPT / ADA CDT / AHA NUBC Copyright StatementĬPT codes, descriptions and other data only are copyright 2022 American Medical Association.
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