Economics
Low back pain (LBP) is the most common and costly disabling condition affecting the industrialized world. Estimated costs in the US exceed $170 billion annually, with approximately $60 billion attributable to medical expenditures and $110 billion related to indemnity costs. Chronic LBP patients consume 80% of the total costs related to this market.
Studies have indicated that U.S. spending on diagnosis and treatment of spinal disorders increased 65% from 1997 to 2005.
Almost 31 million Americans are afflicted with low back pain at any point in time and an estimated 85% of the total population will experience back problems at some juncture in their lives. The source of pain for the majority of these patients is usually related to disc, facet or chronic muscle pathology. It's estimated that 60% is caused by disc and muscle issues, 30% by facet problems and the remaining 10% result from arthritis, scoliosis and other ailments.
Diagnosing and properly treating LBP patients remains a difficult process primarily due to the complexities of the anatomy and physiology of the back. Misdiagnosis results in unnecessary surgery that is expensive and may require revisions.
Every patient who sees a doctor for LBP receives a physical examination. Many have X-rays, CT scans or MRIs, but currently only 15% of people with LBP are accurately diagnosed. The remaining 85% have "non-specific," "soft tissue" injuries of the back. These "soft tissue injuries" are impossible to see with X-rays, CT scans and MRIs.
Facet joint injections and discograms are often used to aid the physician with the diagnosis, but these painful, costly and invasive procedures involve risk with associated side effects and are documented to be wrong up to 50% of the time.
Reimbursement
The standard diagnostic Lumbar Matrix™ Scan has been reimbursed using existing CPT codes. Based on a review of the 2008 American Medical Association CPT codes and recommendation of the Surgical & Medical Coding Committee of the North American Spine Society (NASS), SpineMatrix believes the following procedure code and supporting description is most appropriate and representative for current use when utilizing this new diagnostic technology.
95999 Unlisted neurological or neuromuscular diagnostic procedure*
A functional electrophysiological analysis of the 96 muscles and 60 nerves comprising the thoracolumbosacral neuromuscular system. Nine scans are performed in three functional positions with a physician interpretation by report.
- This code is used because the Lumbar Matrix test has not yet been assigned a specific CPT code by the American Medical Association.
- Unlisted diagnostic procedure codes are used frequently and indicate to the claims examiner that the bill will require manual review.
*CPT 2008 Standard Edition, American Medical Association – Neurology and Neuromuscular Procedures, page 332
