Guideline, Appropriate Use Criteria, and Coverage Criteria Topics by Society

Transcription

1 Guideline, Appropriate Use Criteria, and Coverage Criteria Topics by Society 2018

2 Table of Contents If you would like to add your society s information or update existing information, please contact Amy Yahiro at ayahiro@spine.org American Academy of Orthopaedic Surgeons (AAOS) Page 2-3 American Academy of Pain Medicine (AAPM) Page 4 American Academy of Physical Medicine & Rehabilitation (AAPMR) Page 4 American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Page 5 Section on Spine (AANS/CNS) American Society of Anesthesiologists (ASA) Page 5 American Society of Regional Anesthesia and Pain Medicine (ASRA) Page 6 American Society of Spine Radiology (ASSR) Page 6 Cervical Spine Research Society (CSRS) Page 6 North American Spine Society (NASS) Page 7 Scoliosis Research Society (SRS) Page 8 Spine Intervention Society (SIS) Page 8 1

3 American Academy of Orthopaedic Surgeons (AAOS) Guidelines Jayson N. Murray, MA AUC/Performance Measures Ryan Pezold, MA Director, Department of Manager, Clinical Quality and Value Clinical Quality and Value Development Address Address Phone (847) Phone (847) Website Future Guidelines 1. Management of Surgical Site Infections (2018) 2. Management of Osteoarthritis of the Hip (2017) 3. Surgical Management of Osteoarthritis of the Knee (2015) 4. Management of Carpal Tunnel Syndrome (2016) 5. Management of Hip Fractures in the Elderly (2014) 6. Management of Anterior Cruciate Ligament Injuries (2014) 7. Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants up to Six Months of Age (2014) 8. Treatment of Osteoarthritis of the Knee (2013) 9. Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures (2012) 10. Preventing Venous Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty (2011) 11. The Treatment of Pediatric Supracondylar Humerus Fractures (2011) 12. Diagnosis and Treatment of Osteochondritis Dissecans (2010) 13. Optimizing the Management of Rotator Cuff Problems (2010) 14. Treatment of Symptomatic Osteoporotic Spinal Compression Fractures (2010) 15. Diagnosis of Periprosthetic Joint Infections of the Hip and Knee (2010) 16. Diagnosis And Treatment of Acute Achilles Tendon Rupture (2009) 17. Treatment of Distal Radius Fractures (2009) 18. Treatment of Glenohumeral Joint Osteoarthritis (2009) 19. Treatment of Pediatric Diaphyseal Femur Fractures (2009) 1. Management of Rotator Cuff Injuries - UPDATE (expected 2018, early 2019) 2. Management of Periprosthetic Joint infections - UPDATE (expected 2018, early 2019) 3. Management of Acute Compartment Syndrome DoD Grant Funded (expected 2018) 4. Non-arthroplasty Management of Osteoarthritis of the Knee - UPDATE (expected 2019) 5. Management of Glenohumeral Joint Osteoarthritis UPDATE (expected 2019) 6. Decision to pursue limb salvage or perform early limb amputation DoD Grant Funded (expected 2019) 7. Screening for psychosocial risk and protective factors DoD Grant Funded (expected 2019) 1. Management of Proximal Humerus Fractures 2. Management of Clavicle Fractures 3. Management of Hip Fractures in the Elderly (Update) 4. Management of ACL Injuries (Update) 2

4 AAOS, Continued Completed AUCs AUCs in Progress Future AUCs Completed PMs PMs in Progress Future PMs 1. Management of Developmental Dysplasia of the Hip for Generalists and Referring Physicians (2018) 2. Management of Developmental Dysplasia of the Hip for Orthopaedic Specialists (2018) 3. Management of Osteoarthritis of the Hip (2017) 4. Management of Carpal Tunnel Syndrome (2016) 5. Surgical Management of Osteoarthritis of the Knee (2016) 6. (Prevention of Orthopaedic Implant Infections in Patients Undergoing Dental Procedures (2016) 7. Diagnosis and Treatment of Osteochondritis Dissecans/ Approved Dec Hip Fractures in Elderly Patients: Acute Treatment and Hip Fractures in Elderly Patients: Postoperative/Rehab Approved Dec Prevention of Anterior Cruciate Ligament Injuries and Treatment of Anterior Cruciate Ligament Injuries/ Approved Oct Pediatric Supracondylar Humerus Fractures with Vascular Injury/ Approved June Pediatric Supracondylar Humerus Fractures/ Approved Sept Non-Arthroplasty Treatment of Osteoarthritis of the Knee/ Approved Dec Optimizing the Management of Full-Thickness Rotator Cuff Tears/ Approved Sept Treatment of Distal Radius Fractures/ Approved Mar Management of Surgical Site Infections (expected 2019) 2. Acute Compartment Syndrome DoD Grant Funded (expected 2019) 1. Management of Rotator Cuff Injuries Update 2. Management of Periprosthetic Joint Infections 3. Decision to pursue limb salvage or perform early limb amputation DoD Grant Funded (expected 2019) 4. Screening for psychosocial risk and protective factors DoD Grant Funded (expected 2019) Clinical Performance Measures (PM) 1. Carpal Tunnel Syndrome Discouraging use of MRI for diagnosis of carpal tunnel syndrome Discouraging the use of adjunctive surgical procedures during carpal tunnel release Discouraging the routine use of occupational and/or physical therapy after carpal tunnel release 2. Measure #109 - Osteoarthritis Function and Pain Assessment 3. Management of Hip Fractures in The Elderly: Timing of Surgical Intervention Surgical Management of Osteoarthritis of the Knee Rotator Cuff Injuries Additional Information or Comments Additional Contact: Mary DeMars Administrative Assistant, Quality and Value Unit (847) ; demars@aaos.org 3

5 American Academy of Pain Medicine (AAPM) Guidelines Mary Kay Ams Director of Programs and External Affairs Address Phone (847) Enhanced Recovery After Spine Surgery Protocol 2. Representation on NASS-convened Diagnosis and Treatment of Low-Back Pain American Academy of Physical Medicine & Rehabilitation (AAPMR) Guidelines, AUC, Coverage Address Kate Stinneford Manager, Health Policy Representation on NASS-Convened Diagnosis and Treatment of Low-Back Pain 4

6 American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Section on Spine (AANS/CNS) Guidelines Trish Rehring, MPH, CHES AUC Katie Orrico Coverage Cathy Hill Guidelines Senior AANS/CNS Washington AANS/CNS Senior Manager Office Director Manager, Regulatory Affairs Address Address Address Phone (847) Phone (202) Phone (202) Future Guidelines Completed AUC Future AUCs Future Guidelines 1. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine (2014) 2. Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injuries (2013) 3. Guideline for the Surgical Management of Cervical Degenerative Disease (2009) 1. Thoraco-lumbar Trauma (Accepted for publication, anticipated, September Representation on NASS-Convened Diagnosis and Treatment of Low-Back Pain 3. Metastatic Spinal Tumors (anticipated publication in 2019) 1. Update to Guideline for the Surgical Management of Cervical Degenerative Disease (2018) Collaborated with the American College of Radiology on imaging AUCs related to various spine topics including Low Back Pain, Management of Vertebral Compression Fractures, Myelopathy, Suspected Spine Trauma, Back Pain-Child, Suspected Spine Trauma-Child The ACR periodically updates their AUCs and, as stated above, the AANS and CNS serve on expert panels on the following spine-related topics: Low Back Pain, Management of Vertebral Compression Fractures, Myelopathy, Suspected Spine Trauma, Back Pain-Child, Suspected Spine Trauma-Child Coverage Criteria/Reimbursement No formal proactive coverage policies; provides response to specific proposals as they are released by payors Payor responses to proposed coverage policies are developed on an as needed basis as topics arise. American Society of Anesthesiologists (ASA) Guidelines Madhulika Agarkar : Methodologist Address: M.Agarkar@asahq.org Phone: (847) Practice Guidelines for Moderate procedural sedation and analgesia. (2018) 2. Practice Advisory for the Prevention of perioperative peripheral neuropathies. (2018) 3. Practice Advisory for the Prevention, diagnosis and management of infectious complications associated with neuraxial techniques. (2017) 4. Practice Guidelines: Preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. (2017) 1. Practice Advisory for Perioperative visual loss associated with spine surgery. (2019) 2. Practice Guidelines: Central venous access. (2019) 3. Practice Advisory: Perioperative management of patients with cardiac implantable electronic devices. (2019) 5

7 American Society of Regional Anesthesia and Pain Medicine (ASRA) Name Angie Stengel, MS, CAE Executive Director Address Phone (412) Website 1. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Acute Pain Management From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists (June 2018) 2. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists (June 2018) 3. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition) (April 2018) 4. Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition) (April 2018) 5. Checklist for Treatment of Local Anesthetic Systemic Toxicity (January 2018) 6. Practice Advisory for the Prevention, Diagnosis, and Management of Infectious Complications Associated with Neuraxial Techniques (April 2017) 7. The Second American Society of Regional Anesthesia and Pain Medicine Evidence- Based Medicine Assessment of Ultrasound-Guided Regional Anesthesia (March 2016) 8. Management of Postoperative Pain: A Clinical Practice Guideline February The European Society of Regional Anaesthesia and Pain Therapy and the American Society of Regional Anesthesia and Pain Medicine Joint Committee Practice Advisory on Controversial Topics in Pediatric Regional Anesthesia Sep/Oct The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine: Executive Summary 2015 Sep/Oct Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications May/June Checklist for Treatment of Local Anesthetic Systemic Toxicity Jan Evidence Based Review of Ultrasound Guided Regional Anesthesia Mar/Apr Anticoagulation 3rd Edition Jan/Feb TXA 2. Representation on NASS-Convened Diagnosis and Treatment of Low-Back Pain American Society of Spine Radiology (ASSR) Name Ken Cammarata Business Manager Address kcammarata@asnr.org Cervical Spine Research Society (CSRS) Name Kerri L. Mink Executive Director Address mink@aaos.org Phone (847)

8 North American Spine Society (NASS) Guidelines Amy Yahiro AUC Pamela Hayden Coverage Shweta Trivedi, RHIA Evidence-Based Medicine Manager Director, Research & Quality Improvement Director of Health Policy Phone (630) Phone (630) Phone (630) Website Guidelines: AUC: Coverage: 1. Diagnosis and Treatment of Adult Isthmic Spondylolisthesis (2014) 2. Diagnosis and Treatment of Degenerative Lumbar Spondylolisthesis (Revised 2014) 3. Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy (2012) 4. Antibiotic Prophylaxis in Spine Surgery (Revised 2013) 5. Diagnosis and Treatment of Degenerative Lumbar Spinal Stenosis (Revised 2011) 6. Diagnosis and Treatment of Cervical Radiculopathy from Degenerative Disorders (2010) 7. Antithrombotic Therapies in Spine Surgery (2009) 1. Diagnosis and Treatment of Low Back Pain Completed AUCs 1. Cervical Fusion (2013) AUCs in Progress 1. Degenerative Spondylolisthesis Future AUCs 1. Adult Isthmic Spondylolisthesis 2. Pediatric Spondylolisthesis Completed Coverage Recommendations Coverage Recommendations 1. Allograft and Demineralized Bone Matrix for Spinal Fusion (October 2017) 2. Cervical Artificial Disc Replacement (November 2015) 3. Cervical Fusion (July 2015) 4. Cervical Laminoplasty (July 2014) 5. Coccygectomy (October 2016) 6. Discography (June 2018) 7. DNA-Based Scoliosis Test (October 2016) 8. Electrical Stimulation for Bone Healing (October 2016) 9. Endoscopic Discectomy (May 2014) 10. Epidural Cervical Injections (May 2014) 11. Facet Joint Interventions (October 2016) 12. Interspinous Device without Fusion (May 2014) 13. Interspinous Fixation with Fusion (May 2014) 14. Intrathecal Drug Delivery Systems (March 2017) 15. Laser Spine Surgery (May 2014) 16. Lumbar Artificial Disc Replacement (May 2014) 17. Lumbar Discectomy (May 2014) 18. Lumbar Epidural Injections (May 2014) 19. Lumbar Fusion (May 2014) 20. Lumbar Interspinous Device without Fusion and with Decompression (May 2018) 21. Lumbar Laminectomy (October 2014) 22. Lumbar Laminotomy (May 2014) 23. Percutaneous Sacroiliac Joint Fusion (June 2015) 24. Percutaneous Thoracolumbar Stabilization (May 2014) 25. Recombinant Human bone Morphogenetic Protein (rhbmp-2) (May 2014) 26. Sacroiliac Joint Injections (November 2015) 27. Spinal Cord Stimulation (October 2017) 7

9 Scoliosis Research Society (SRS) Guidelines/AUC Tressa Goulding, CAE Executive Director Address Completed AUC The Appropriateness of Surgical Treatment Approaches for Lumbar Degenerative Scoliosis (2015) Spine Intervention Society (SIS) Guidelines, AUC, Coverage Belinda Duszynski Senior Director of Policy and Practice Address Phone (630) , ext Practice Guidelines for Spinal Diagnostic and Treatment Procedures (2013) 1. Safety Practices for Interventional Spine Procedures 2. Representation on NASS-Convened Diagnosis and Treatment of Low-Back Pain Completed AUC 1. Multisociety Collaboration: Fluoroscopically-Guided Sacroiliac Interventions (2015) Completed Coverage Recommendations Coverage Criteria/Reimbursement Developed by the Multi-Society Pain Work Group (MPW) 1. Facet Joint Injections and RF Neurotomy 2. Lumbar Epidural Steroid Injections 3. Cervical Epidural Steroid Injections 4. Spinal Cord Stimulators 5. Vertebroplasty/Kyphoplasty 6. Overarching Pain Policy (chronic patient evaluation/ documentation) 8