Computer-assisted surgery for orthopedic procedures of the appendicular skeleton (pelvic girdle, pectoral girdle and bones of the upper and lower limbs) (0054T, 0055T, 0056T) is considered a noncovered service.  Published medical literature evidences a lack of controlled clinical trials and does not permit conclusions regarding whether computer-assisted navigation will result in significant clinical improvements in patients undergoing orthopedic procedures.  No additional allowance is provided for the computer-assisted technique.    Procedure code 0054T, 0055T, or 0056T should be reported in addition to the code for the actual surgical procedure.  When procedure code 0054T, 0055T, or 0056T is reported, it should be denied as noncovered since the code is not representative of the 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.

PRN References

10/2006, Computer-assisted musculoskeletal surgical navigational orthopedic procedures noncovered

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