Charges for computer-assisted guidance for orthopedic procedures of the appendicular skeleton (pelvic girdle, pectoral girdle and bones of the upper and lower limbs - codes 20985, 0054T, and 0055T, are not eligible for payment.  Surgical procedures performed with the aid of computer-assisted musculoskeletal surgical navigational orthopedic guidance should be reported under the existing code for the actual procedure performed.  No additional allowance is provided for the computer-assisted technique. When procedure code 20985, 0054T, or 0055T is reported, it should be denied as a noncovered service since the code is not representative of the actual surgical procedure being performed. Computer-assisted musculoskeletal surgical navigational orthopedic techniques are not separately covered and are not eligible for payment.  A participating, preferred, or network provider cannot bill the member for such services.

Description

Conventional fluoroscopic guidance provides imaging in one plane.  Computer-assisted musculoskeletal surgical navigational orthopedic procedures involve the use of navigation systems that provide additional information and attempt to further integrate preoperative planning with intraoperative arthroplasty orientation or fracture alignment and fixation.  Orthopedic computer-assisted surgeries most commonly involve hip and knee arthroplasty procedures, as well as fixation of pelvic, acetabular, or femoral fractures that typically require the percutaneous placement of screws or guidewires.  Computer-assisted surgery is considered an alternative to existing image guidance using fluoroscopy. 

Computer-assisted navigation involves 3 steps:  data acquisition, registration, and tracking.

Data Acquisition

Data can be acquired in 3 different ways:  fluoroscopic, guided by computed tomography (CT) or or magnetic resonance imaging (MRI), or imageless systems.  The imageless systems rely upon information such as centers of rotation of the hip, knee, or ankle or visual information such as anatomical landmarks.  These data are then used for registration and tracking. 

Registration

Registration refers to the ability of relating images (i.e., x-rays, CT, MRI, or patient’s 3D anatomy) to the anatomical position in the surgical field.  Early registration techniques required the placement of “fiduciary markers” in the target bone, which required an additional surgical procedure.  More recently, a surface-matching technique has been developed in which the shapes of the bone surface model generated from preoperative images are matched to surface data points collected during surgery.

Tracking

Tracking refers to the sensors and measurement devices that can provide feedback during surgery regarding the orientation and relative position of tools to bone anatomy.  For example, optical or electromagnetic trackers can be attached to regular surgical tools, which can then provide real time information relating to the position and orientation of the tools’ alignment with respect to the bony anatomy of interest.

This medical policy may not apply to FEP.  Medical policy is not an authorization, certification, explanation of benefits or a contract.  Benefits are determined by the Federal Employee Program.

Validation and Usefulness of a Computer-Assisted Cup-Positioning System in Total Hip Arthroplasty, Journal of Bone and Joint Surgery, Vol. 89(3), 03/2007

A Prospective, Randomized Study of Computer-Assisted and Conventional Total Knee Arthroplasty.  Three Dimensional Evaluation of Implant Alignment and Rotation, Journal of Bone and Joint Surgery, Vol. 89(2), 02/2007

When Computer-Assisted Knee Replacement is the Best Alternative, Clinical Orthopedics and Related Research, Vol. 452, 11/2006

Precision in Orthopaedic Computer Navigation, Orthopade, Vol. 35(10), 10/2006

Computerized Navigation for the Internal Fixation of Femoral Neck Fractures, Journal of Bone and Joint Surgery, Vol. 88(8), 08/2006

National Blue Cross Blue Shield Association Medical Policy 7.01.96, Computer-assisted Musculoskeletal Surgical Navigational Orthopedic Procedure, 04/2006

Computer-Assisted Total Knee Arthroplasty: Comparative Results in a Preliminary Series of 72 Cases, Acta Orethopaedica Belgica, Vol. 71(6), 12/2005

Functional Impact of Navigation-Assisted Minimally Invasive Total Knee Arthroplasty, Orthopedics, Vol. 28, 10/2005

Computer-Assisted Navigation in Total Knee Arthroplasty: Improved Coronal Alignment, Journal of Arthroplasty, Vol. 20, 10/2005

Computer-Assisted Navigation in Total Knee Arthroplasty: Comparison With Conventional Methods, Journal of Arthroplasty, Vol. 20, 10/2005

Computer-Assisted Navigation Increases Precision of Component Placement in Total Knee Arthroplasty, Clinical Orthopedics and Related Research, Vol. 433, 04/2005