Reimbursement Issues

Very informative discussion. Thanks for everyone's contribution. I am looking at a job with them.

 

Is it illegal to code for an ALIF when you have done an XLIF?

 

What do you think?

 

What is the XLIF code or direct lateral code then?

There isnt one, the only guidance that has been given is from NASS as to code as an ALIF or Anterior fusion.

So your logic is incorrect

 

I think the DOJ will figure it out. They are out to get all the spine companies for there unethical practices. An ALIF is completely different than an XLIF. There is no code for XLIF, that is why it is being classied as investigative. You can take Alex out of Danek, but you cannot take the Danek out of Alex.

 

Im sorry, but the DOJ has better things to do than investigate this. Many insurance companies are catching on to this "creative" coding, but lets face it folks, this is not improper. Its improper for insurance companies NOT to accept this as a reimbursed procedure. It is a good procedure that causes less trauma to the patient, quicker recovery times, and better shorter OR time than a ALIF, and less bleeding complications.
The fraud going on here is the lack of insurance companies to realize that this is new, it works, and it is here to stay. Get used to it and accept it.
BTW...are you saying that this is not an "anterior fusion"??

 

It is a lateral fusion!

 

XLIF is just a brand name. later approaches have been around for a long time. this is not a DOJ issue or a case of bad medicine. Q: are you accessing the anterior column with and ALIF? A: Yes. Q: Are you accessing the anterior column with and XLIF? A: Yes.

I cant think of any "approach" that is classified as investigational?? if i am wrong please let me know? XLIF is NOT a device like TDRs or Xstop. XLIF is the brand name given by a compay (nuvasive) who uses a retractor to place a PEEK cage.... is a MIS TLIF via a Metrx tube investigational.........................NO

 

You are wrong. You cannot code it as an ALIF because it is a different approach. It is a lateral approach. Therefore it cannot be coded as an ALIF. Short the stock.

 

First off, read the NASS letter from January. It states to code as an ALIF. Second, Aetna just gave approval and stock went up almost $10.

 

so glad i bought a ton of stock last week. yesss!!!!!!!!!!!!!!

 

Spike then flat again! Wow, that is the "ONE TRICK PONY!"

 

OK, so they got NASS (read: one or two surgeons receiving consulting dollars) to write a letter. Bully for them. And this got Aetna to reverse their policy. I used to work for Aetna and their medical directors do not hold a high bar of clinical superiority for therapies. Aetna's national enrollment- on the downward slide.

The true test is that if/when BCBS (100+ mil lives) reviews this and posts a negative position on the procedure, it'll be very tough for Nuvasive to overcome without new clinical data and/or a coding revision. You might want to take that $10 gain and cut bait.

 

I could not agree more. The problem we have is we all drink the "PURPLE KOOLAID." We are addicts and we do not know how to stop. I love doing 4 to 6 level XLIF case and all that cash, f the patient we do not care. We have zero ethics!

 

Are you guys charging higher prices this year?

 

I'm a patient who has been denied xlif twice. I have lumbar stenosis, bulging discs, facet disease, degenerative disc disease, lumbar scoliosis and my spine is twisting off center. I put off having a disc removed for ten years so I don't rush into surgery. I've tried conservative approaches and am now allergic to codeine so I have no pain relief at this time... My insurance did cover did cover xlif in 2009 but dropped it in January of 2010. I've had to quit my job...

 

What is the deal with you guys...Don't you ever report to the FDA that you injured a patient or howyou break implats insitu and then you leave part of it in the disc space bc cannot retrieve I know of 5 instances and and still have not seen on Maude?????

 

The FDA don't give a squat if patients are being crippled. I'm sure they love their 'gifts' just as well as the doc's doing the cutting.