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X STOP Interspinous Process Decompression (IPD) System (GEN) - Revised 6-20-07
Posted June 20, 2007
This carrier will allow coverage for the use of the X STOP Interspinous Process Decompression System (IPD) effective January 1, 2007, under the conditions as allowed in the Food and Drug Administration (FDA) premarket approval. The device is indicated for treatment of patients aged 50 and older suffering from neurogenic intermittent claudication secondary to confirmed diagnosis of lumbar spinal stenosis (with x-ray, MRI, and/or CT evidence of thickened ligamentum flavum, narrowed lateral recess and/or central canal narrowing).
The X STOP is indicated for those patients with moderately impaired physical function who experience relief in flexion from their symptoms of leg/buttock/groin pain, with or without back pain, and have undergone a regimen of at least six months of nonoperative treatment. The X STOP may be implanted at one or two lumbar levels in patients in whom operative treatment is indicated at no more than two levels.
The device is further restricted insofar as the labeling specified requirements that apply to the training of practitioners who may use the device. Effective January 1, 2007, there are two Category III codes to describe X STOP.
- CPT code 0171T - First level X STOP implant. Insertion of posterior spinous process distraction device (including necessary removal of bone or ligament for insertion and imaging guidance), lumbar, single level.
- CPT code 0172T - Subsequent level X STOP implant. Insertion of posterior spinous process distraction device (including necessary removal of bone or ligament for insertion and imaging guidance), lumbar; each additional level (list separately in addition to code for primary procedure). Use 0172T in conjunction with code 0171T.
The appropriate ICD-9-CM code is 724.02 (Spinal stenosis, lumbar region).
CPT code 0171T is used for the first level X STOP implant and the numeral 1 is entered in Item 24G of the CMS-1500 claim form or the electronic equivalent with the number of days or units. If a second lumbar level procedure X STOP implant is carried out, use CPT code 0172T and enter 1 in the Item 24G of the CMS-1500 claim form or the electronic equivalent, the number of days or units field. If the X STOP procedure is carried out at two lumbar levels, you must bill the primary code 0171T and the subsequent level code 0172T on the same claim. Assistant at surgery will not be separately paid. |
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