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7.01.84Archivada FUSION VERTEBRAL LUMBAR MINIMAMENTE INVASIVA
SecciónCirugía Fecha Original: 1 de agosto de 2011
Subsección Fecha Revisión22 de agosto de 2017
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Definición


Fusión de la columna vertebral lumbar se puede realizar por distintos abordajes, anterior, posterior o lateral. El abordaje anterior o posterior (ALIF/PLIF) tradicionalmente se realizan utilizando un abordaje abierto, pero también se pueden realizar de forma mínimamente invasiva. Procedimientos que se describen como mínimamente invasivos varían desde técnicas percutáneas hasta incisiones pequeñas que reducen significativamente la retracción muscular al usar retractores especializados. La cirugía de fusión vertebral incluye la descompresión del canal vertebral, colocación de jaulas intersomaticas (cages), trasplante óseo, material osteoinductivo, y tornillos y varillas. Procedimientos mínimamente invasivos incluye la colocación de todos los tornillos y varillas de manera percutánea o por incisiones pequeñas.
Fusión vertebral anterior (ALIF) provee una visualización directa del espacio del disco y potencialmente permite una discestomia más completa y mejor fusión que los abordajes laterales y los posteriores. También evita trauma a los músculos paraespinales, cicatriz epidural, y tracción de las raíces de los nervios. Aumenta el riesgo de daño al retraer los grades vasos y al plexo simpático superior hipogástrico.
Fusión vertebral posterior (PLIF) se realiza de forma abierta a través de una incisión mediana o paramediana. En el abordaje mínimamente invasivo utiliza retractores tubulares para lograr acceso a los pedículos y al foramen. PLIF típicamente incluye laminectomias parciales y facetectomias.
Fusion vertebral trans foraminal (TLIF) a través de un retractor tubular colocado mas lateral y se realiza una laminectomia parcial y facetectomia. Permite acceso a los elementos posteriores y al espacio interdiscal.
Fusion Vertebral Lateral (fusión vertebral lateral extrema {XLIF} o fusión lateral directa {DLIF}. Esta modalidad utiliza retractores especializados para realizar un abordaje a la parte anterior de la vertebra a través del psoas. Esta modalidad pone los nervios del plexo lumbar a mayor riesgo y reduce la posibilidad de realizar una discestomia completa. El monitoreo electromiográfico es necesario para reducir daño a los nervios.
Fusion Lumbar Axial (AxiaLIF) Este es un abordaje percutáneo también conocido como fusión trans –sacral o fusión vertebral paracoccigial. Bajo control fluoroscopico se introduce un guía por una pequeña incisión lateral al cóccix y se avanza por la superficie anterior del sacro. Se introducen dilatadores y bajo control fluoroscopico de remueven los núcleos pulposos.
Política
Los siguientes procedimientos se reconocen para pago:
Fusión anterior:
  • ALIF-abierto

    • Fusión posterior:
  • PLIF-abierto o mínimamente invasivo (MI)

    • Fusión Transforaminal:
  • TLIF-abierto o mínimamente invasivo(MI)

    • Los siguientes procedimientos no proceden para pago:
    Fusión lateral:
  • XLIF(extreme lateral) –mínimamente invasivo

  • DLIF (direct lateral)-mínimamente invasivo

  • AxiaLIF- mínimamente invasivo

    • Fusión anterior laparoscópica – ALIF Laparoscópica
    Códigos
    V1 V2
    CPT Description
    22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar
    22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed)
    22614 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure)
    22630 Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar
    22632 Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; each additional interspace (List separately in addition to code for primary procedure)
    22845 Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure)
    76000 Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time, other than 71023 or 71034 (eg, cardiac fluoroscopy)
    76380 Computed tomography, limited or localized follow-up study

    V1 V2
    CPT (Deleted 12/31/2016) Description
    22851 Application of intervertebral biomechanical device(s) (eg, synthetic cages(s), methylmethacrylate) to vertebral defect or interspace (List separately in addition to code for primary procedure)

    V1 V2
    CPT (Effective date 01/01/2017) Description
    22853 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring(eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure)
    22854 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring(eg, screws, flanges), when performed, to vertebral corpectomy(ies)(vertebral body resection, partial or complete0 defect, in conjunction with interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)
    22859 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebraldisc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)

    V1 V2
    HCPCS (Deleted 06/30/2011) Description
    C9729 Percutaneous laminotomy/laminectomy (intralaminar approach) for decompression of neural elements (with ligamentous resection, discectomy, facetectomy, when performed), any method under indirect image guidance, with the use of an endoscope when performed, single or multiple levels, unilateral or bilateral; lumbar (new code effective 4/1/11)

    V1 V2
    ICD-9 Description
    722.10 Lumbar intervertebral disc without myelopathy
    722.51-722.52 Degeneration of thoracolumbar, lumbar, lumbosacral intervertebral disc, code range
    722.73 Lumbar region
    724.02 Lumbar region, without neurogenic claudiation
    724.03 Lumbar region with neurogenic claudication
    724.4 Thoracici or lumbosacral neuritis or radiculitis, unspecified / Radicular syndrome of lower limbs
    738.4 Acquired spondylolisthesis / Degenerative spondylolisthesis spondyloslysis, acquired
    V45.4 Arthrodesis status

    V1 V2
    ICD-10-CM (effective date 10-1-13) Description
    M43.15-M43.16 Spondylolisthesis, codes for thoracolumbar and lumbar region
    M48. 05-M48.06 Spinal stenosis, codes for thoracolumbar and lumbar regions
    M51.05-M51.06 Intervertebral disc disorders with myelopathy, codes for thoracolumbar and lumbar region
    M51.15-M51.16 Intervertebral disc disorders with radiculopathy, codes for thoracolumbar and lumbar regions
    M51.35-M51.36 Other intervertebral disc degeneration, codes for thoracolumbar and lumbar regions
    M96.0 Pseudarthrosis after fusion or arthrodesis

    V1 V2
    ICD-10-PCS (effective 10-1-13 Description
    0SG033J, 0SG034J, 0SG037J, Surgical, lower joints, fusion, percutaneous, posterior approach,
    0SG03JJ, 0SG03KJ, 0SG13JJ, Anterior column, code by body part (lumbar vertebral joint, lumbar
    0SG134J, 0SG137J, 0SG13JJ, Vertebral joints one more, or lumbosacral joint) and device
    0SG13KJ, 0SG333J, 0SG334J, Interbody fusion device, internal fixation device, autologous tissue
    0SG337J, 0SG33JJ, 0SG33KJ, Subtitute, synthetic substitute, nonautologous tissue subtitute

    Limitación
    Estos servicios deben estar autorizados por el Programa de Manejo Individual.
    ___________ ____________________________________
    Ángela Hernández, MD Benjamín Santiago, M.D.
    Director Médico Asociado V.P. División Manejo Medico
    Rev. 08/22/2017

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