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Determination Of Work Relative Value Units For Management Of Lumbar Spinal Stenosis By Open Decompression And Interlaminar Stabilization London Spine

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BACKGROUND: Effective January 1, 2017, open surgical decompression and interlaminar stabilization (ILS) received a Category I Current Procedural Terminology (CPT®) code 22867. The current work relative value units (wRVUs) assigned to the procedure of 13.5 are not reflective of the amount of work involved. During the survey process, CPT® 22867 was erroneously assessed with a percutaneous “sister” code (CPT® 22869), which is performed with no decompression (but within the same new “family”) and…Lumbar Disc Replacement Expert. Best Spinal Surgeon UK


Background: Effective January 1, 2017, open surgical decompression and interlaminar stabilization (ILS) received a Category I Current Procedural Terminology (CPT®) code 22867. The current work relative value units (wRVUs) assigned to the procedure of 13.5 are not reflective of the amount of work involved. During the survey process, CPT® 22867 was erroneously assessed with a percutaneous “sister” code (CPT® 22869), which is performed with no decompression (but within the same new “family”) and primarily by nonsurgeons. However, similar CPT® code descriptors assigned to each of these new codes undermined their procedural differences during the survey process and generated confusion among physician survey responders, the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC), and ultimately the Centers for Medicare and Medicaid Services (CMS) regarding the value of ILS. The resulting physician payment determination for the ILS procedure has had severe deleterious effects on this procedure being offered to lumbar spinal stenosis (LSS) patients. Our independent society-driven survey presents new data that assess the accuracy of the assigned wRVUs for CPT® 22867.

Methods: An independent survey was driven by the International Society for the Advancement of Spine Surgery (ISASS) in November 2018 and sent to 58 US surgeons with experience performing open decompression with ILS (CPT® 22867) and without financial conflicts of interest as analogous to RUC survey financial disclosure requests. Respondents were asked to compare CPT® 22867 with a list of 10 other comparator CPT® codes reflective of common spine surgeries. The survey presented each comparator CPT® code with its code descriptor and corresponding wRVUs alongside the code descriptor for CPT® 22867. A patient vignette was also provided that describes a typical clinical scenario for the surveyed procedure. Respondents were then asked to indicate which comparator CPT® code on the reference list is most similar to the survey code descriptor and typical patient/service vignette provided, as well as specify estimated wRVUs for CPT® 22867 relative to their selected comparator CPT® code. The surgeons’ responses were analyzed to determine comparator CPT® codes and estimated wRVUs.

Results: Among the 28 surgeons who responded to the survey, both open decompression codes (57.1%) and fusion codes (42.9%) were chosen as most similar to the typical patient/service for CPT® 22867. Furthermore, the laminectomy procedure (CPT® 63047) was chosen as the surveyed surgeons’ model response for a reference procedure in terms of similar work intensity and time for CPT® 22867. After calculating the difference between the selected comparator codes and estimated wRVUs, nearly all respondents had a positive calculated difference, indicating that surgeons selected wRVUs lower than they deemed appropriate as a result of the listed CPT® codes they were required to use. In the spirit of the Rasch analysis, the regression analysis estimated wRVUs for CPT® 22867 that are greater than its assigned wRVUs (13.5) and its most comparable procedure (CPT® 63047; reference wRVUs: 15.37).

Discussion and conclusions: The survey results indicate that the wRVUs assigned to CPT® 22867 are significantly undervalued at 13.50 and have directly resulted in the underreimbursement for surgeons performing the ILS procedure. This misvaluation of the code has created a supply-and-demand anomaly in which the rate of ILS procedures has flatlined despite increasing rates of fusion procedures and an increasing older population. This anomaly is a cause of concern for policy makers and the health care community for the future of safeguarding patient welfare and procedural innovation. Therefore, understanding the clinical economic impact and appropriately addressing potential misvalued codes, such as the ILS procedure, are critical to protecting the future of patient care.

Keywords: CPT® 22867; current procedural terminology (CPT®); decompression; interlaminar stabilization (ILS); lumbar spinal stenosis (LSS); physician payment; relative value units (RVUs).

The London Spine Unit : top spinal facility in the worldRead more from the original source:Determination of Work Relative Value Units for Management of Lumbar Spinal Stenosis by Open Decompression and Interlaminar Stabilization

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Radu Ghebaru
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Ashraf Elawad
Ashraf Elawad
I had difficult times with my disc prolapse in my lower back. The pain was getting worse despite pain killers and physiotherapy. I was a bit nervous considering surgical treatment as a definte solution. The consultation with Mr. Mo Akmal was informative and reassuring and helped me to make a decision going ahead for the surgical option. On the day of the procedure, the staff was welcoming and looked experienced and knew exaclty what they were doing. Mr. Mo Akmal spoke to me before and after the procedure. In less than 2hrs, after the porcedure, I was able to stand, walk, and sit down with no pain. I strongly recommend Mr. Mo Akmal for anybody who has a similar condition.
Joe massimo
Joe massimo
I had minimally invasive spinal surgery for a Bulging disc at L5/S1 impinging on my S1 nerve root. Before surgery I couldn’t walk without a limp and would be in too much pain to walk further than a mile. Being only 21 years old and a keen athlete and student Osteopath, with an interest in sports rehabilitation, I wanted to get back to complete health and fitness from this injury. There is definitely a fear with spinal surgery that a lot of people have in the sports and therapy world however I knew I needed the operation to gain my leg function back and with Mr Mo Akmal and the team at the London spine Unit, I felt in great hands and they were very professional from start to finish with the process. They made me feel very comfortable and safe. I’d highly recommend Mr Mo Akmal and the Team at the London Spine Unit, they are very friendly and take great care of you. I’m feeling much better and am glad I chose to get the surgery done here.
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In February 2021 I felt excoriating pain in my lower back. I was unable to stand up straight with my right leg having spasms occurring every hour. The sciatic pain accelerated within days I was bed bound to the point I needed help with basic daily activities such as making a cup of tea. I read the reviews about Dr Akmal, which I found beneficial and decided to book a consultation to see him. I was booked for a Consultation with Dr Akaml as well as an MRI scan & blood tests. I was pleasantly surprised to find out that I would get the results on the same day with the treatment options. Dr Akmal was very friendly he discussed the MRI scan with me that showed disc L4-L5 impinging the nerve, he suggested two options. One was the laser treatment to shrink the disc or the second the option was a discectomy. This would be a day procedure with no overnight stay. At no point did I feel pressured to decide on the procedures. Dr Akmal is incredibly knowledgeable this was evident through his years of experience with spinal procedures, I was 100% that the best option would be the discectomy and the best Surgeon was Dr Akmal. I was so impressed with the service and care that was offered at the clinic it was no less than first class to be honest, with no waiting time at all. On the day of the procedure I was in a private room, a lovely healthcare assistant was there to help me get into the hospital gown. Every staff member was ever so kind, they all made me feel at ease. Once I woke up I felt no sciatic pain at all which was an amazing feeling, an emotional moment to finally be rid of that burning sensation. Of course, there was some slight discomfort where the procedure had taken place. After surgery, I was able to stand on my two feet as well as being able to walk without any discomfort. Finally making my own cooked breakfast was a heavenly feeling! I can say with complete confidence that I trust Dr Akmal he is no doubt, on top of his field, a great human being who I’m so grateful to have met. If you want your life back I would highly recommend you book yourself in for a consultation with Dr Akmal, he is worth every single penny! Thank you Dr Akmal!
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Sam Sahota
Sam Sahota
My personal experience of The London Spine Unit in Harley Street London and the whole team of surgeon Mo Akmal written two weeks after my Surgery . It’s been an absolutely amazing experience. I am a 58 year old male . Many years ago I was breaking some concrete with a very large sledgehammer that’s where all my problems started. During these many years I have undergone Facet joint injections, many appointments with Osteopaths,Chiropractors,Acupuncture,Massages etc etc the list is endless.They would be helpful for a few days and then the pain in my back and weakness in my legs would return. 2019 had Mri of lumbar area showed disc bulge trapping nerves in l4/5 areas I underwent an open surgery on Nhs to cut away part of the disc that was causing the problem.I was in hospital for 5 days and recovery took many months, Then the pain returned!!I then decided to live with the unbearable pain as I couldn’t go through all that again, I was recommended to Mo Akmal, he arranged a much clearer Mri within two hours he took a look and identified the problem the following week after my pre op assessment my keyhole surgery was done within 2 hours , immediately I was pain free I noticed immediately the pain free sensation I was very happy with the outcome , it was so simple , I could walk painfree. I came in a taxi in the morning and took a taxi back home in the evening . Mo akmal Is a very professional surgeon it was like talking to a friend no rush at all , didn’t even seem like a surgery, Member of his team calls me three times a week to see how I’m getting on. Now I don’t even think about my back as I have zero pain , I sleep well, I feel much better from within, I have no hesitation in recommending Mo Akmal . I am a person that does so much research into things like this as I know the risks aswell as the benefits,I jumped at the opportunity that was given to me for this keyhole surgery. I did not tell anyone of my friends as they really did not know the pain I was in and if I had told them I know they would of discouraged me of going ahead. 2 weeks later I feel totally pain free. If in any doubt I do not mind Mo giving my email to anyone as long as I can help them out of pain .i was always told use hot and cold packs on your back , it didn’t help much mine was a much more deep rooted problem that need proper intervention I have learnt over the years that very seldom will a therapist ever tell you to get an MRI to see exactly what is going on inside your body it’s left to your own judgement, no amount of alternative therapy would of actually helped my problem if I wanted to get to the root of the problem..It’s your choice to go ahead with treatment or not BUT atleast you will know and have a better understanding of exactly what is causing your problem. I would say Don’t suffer in silence do something about it like I did .
Mrs Michelle Hunter
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I would highly recommend Mr Mo Akmal and his team at the London Spine Unit. I have had issues with my lumbar spine for over 20 years and have struggled to find someone who could help. My situation was complicated by a separate neurological diagnosis 7 years ago. Mr Akmal listened to my medical history and offered informed and honest advice, taking a holistic view based on his extensive experience and listening to my opinion with an open mind. I have had 2 minimally invasive procedures at the London Spine Unit during the Covid pandemic. I felt very safe and well looked after on both occasions. The results were great, they allowed me to finally exercise without pain & weakness and to play with my 2yr old! (Which was very important with nursery closures in Scotland!). I still have a way to go but I feel like I have finally found someone who genuinely cares and understands, and I am no longer alone with my health journey. Thank-you Mr Akmal and your amazing team!!
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I had been suffering with a trapped nerve in my back for 18 months which meant I could only stand for about an hour and I couldn’t sit in a chair. I was spending 70% of my day lying down. I had been off work all this time on universal credit (£80 a week). Four different doctors and two consultants said it was a muscle problem. NHS finally agreed to give me an MRI which clearly showed my L5/S1 disc was badly worn, the L5 vertebrae was arthritic and the vertebrae were rubbing together but still they told me it was a muscle problem. One consultant told me I was imagining my leg pain and said to buy a tennis ball and massage my muscle with it by pushing it into my back! I then went to a private hospital in Aberdeen, the consultant there was very arrogant and told me fusing vertebrae and replacing discs didn’t work. He said my problem would go away after a couple of years! This is when I found Mr Akmal! I did an internet search and while I was reading about The London Spine Clinic one of Mr Akmal’s team asked me via web chat if they could help. I briefly explained my back problem and arranged an appointment over the phone for the next day. I uploaded my MRI and Mr Akmal phoned me with his diagnosis. He gave me a fair and honest opinion and said I could take his diagnosis and get treatment elsewhere as I live 700 miles away. Mr Akmal said there was nothing left of my disc and needed an operation. After more fobbing off by the NHS I decided to get the surgery done by Mr Akmal. I flew from Orkney to London on my own on the Sunday, had the operation on the Monday. I went back to my accommodation 2.5 hours after the operation in a taxi. I went back for a check up by Mr Akmal on the Tuesday and flew home to Orkney on the Wednesday. The operation was for: Posterior Lumbar Decompression + Instrumented Fusion. I am so glad I chose Mr Akmal and The London Spine Clinic for this procedure. My whole experience from start to finish was amazing. All the staff were really friendly and helpful. Mr Akmal’s skill, experience and passion for helping people really shines through. The follow up appointments have been excellent. The whole experience was so laid back it doesn’t feel like I had major back surgery 18 days ago. My pain has completely gone. I walked 3 miles for the first time in 2 years the other day. I cannot put into words how this has changed my life! If you have back pain I cannot recommend Mr Akmal highly enough, he will give you an honest opinion and offer the best solution for your problem.

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Abstract Background: Effective January 1, 2017, open surgical decompression and interlaminar stabilization (ILS) received a Category I Current Procedural Terminology (CPT®) code 22867. The current work relative value units (wRVUs) assigned to the procedure of 13.5 are not reflective of the amount of work involved. During the survey process, CPT® 22867 was erroneously assessed with…
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