Instant vertebral assessment (IVA) is considered an experimental/investigational procedure for all indications, including screening for vertebral fractures with dual energy x-ray absorptiometry (DEXA). When reported, this procedure will be denied as experimental/investigational. A participating, preferred, or network provider can bill the member for a service denied as investigational.

Recent studies have focused on instant vertebral assessment as part of an osteoporosis risk assessment program. However, published information has not established the clinical impact of instant vertebral assessment on diagnosing vertebral fracture or risk of fracture, therapeutic treatment management, and long-term patient outcomes. Further research is necessary to establish standardized indications for performing this study, interpreting the results, and proving its clinical utility among various patient populations. 

Description

Instant vertebral assessment (IVA) is an imaging method for identifying vertebral fractures or deformities in patients at risk for osteoporosis or osteoporotic fractures. It is also commonly called morphometric x-ray absorptiometry (MXA) or lateral vertebral assessment (LVA). The IVA technology is an add-on feature to the dual energy x-ray absorptiometry (DEXA) scanner or densitometer. Using this method, lateral images of the spine can be obtained by performing a 10 second, low-dose single energy scan without subjecting the patient to a separate x-ray procedure.

IVA is typically performed during the same patient encounter for a DEXA scan. It provides the physician with a rapid assessment of the presence or absence of vertebral deformity(ies) including, vertebral fractures. Through this new method, the provider can magnify particular areas of interest or view the entire spine at once.

For additional information on bone density studies, refer to Medical Policy Bulletin X-24.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Under the Federal Employee Program, all services that utilize FDA-approved drugs, devices, or biological products are eligible when intended for the treatment of a serious or life-threatening condition and when medically necessary and appropriate for the patient’s condition. Instant vertebral assessment (IVA) is considered eligible when determined medically necessary based on the patient’s condition.

PRN References

12/2004, Instant vertebral assessment considered investigational

National Blue Cross Blue Shield Association Medical Policy #6.01.44

Position Statement: Technical Standardization for Dual-Energy X-ray Absorptiometry, The Writing Group for the International Society of Clinical Densitometry, Journal of Clinical Densitometry, Vol. 7, Issue 1, Spring, 2004

Instant Vertebral Assessment, A Noninvasive Dual X-ray Absorptiometry Technique to Avoid Misclassification and Clinical Management of Osteoporosis, Journal of Clinical Densitometry, Vol. 4, No.4, Winter 2001

Recognizing and reporting osteoporotic vertebral fractures, European Spine Journal (September 2003), Vol. 12 (Suppl. 2)

Clinical utility of dual-energy vertebral assessment (DVA), Osteoporosis International, Vol. 14, (2003)

Prevalence of Vertebral Compression Fracture Deformity by X-ray Absorptiometry of Lateral Thoracic and Lumbar Spines in a Population Referred for Bone Densitometry, Journal of Clinical Densitometry, Vol. 5, No. 3, Fall 2002

Vertebral Fractures in Osteoporosis: A New Method for Clinical Assessment, Journal of Clinical Densitometry, Vol. 3, 2000