Computer-assisted Navigation Systems for Orthopedic Surgery

Medical Policy: 06.01.24 
Original Effective Date: January 2007 
Reviewed: March 2008 
Revised:  

This policy applies to all products unless specific contract limitations, exclusions or exceptions apply. Please refer to the member's coverage manual for benefit availability. Managed care guidelines related to referral authorization, and precertification of inpatient hospitalization, home health, home infusion and hospice services apply.

Description: 

Computer-assisted navigation systems integrate preoperative planning and intraoperative execution information by displaying three dimensional (3D) computer images in relation to patient anatomy. These systems consist of a computer workstation with image processing and surgical planning software, a localization/digitization system and a display monitor. Computer software enables the surgeon to measure distances, angles, and volumes, and rotate and zoom to determine cutting planes and implant positioning.

Computer-assisted navigation involves three processes: data acquisition, registration, and tracking. Data can be acquired in three different ways including fluoroscopic, computed tomographic (CT) or magnetic resonance imaging (MRI)-guided or imageless systems. Registration establishes a spatial relationship between all image locations and the corresponding locations on the patient. A surface-matching technique can be used in which the shapes of the bone surface model generated from preoperative images are matched to surface data points collected during surgery. 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 providing real-time information.

Computer-assisted navigational surgical techniques are emerging as an adjunct to fixation of pelvic, acetabular, or femoral fractures, and as an adjunct to hip and knee arthroplasty procedures.

The existing literature provides insufficient evidence to determine whether using computer-assisted navigation systems for orthopedic surgery reduces post-procedure complications and impacts functional outcomes and long-term effects, including implant longevity, need for revision, pain, and quality of life.

 

Policy: 

Computer-assisted navigation systems for orthopedic surgery are considered investigational.


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Procedure Codes and Billing Guidelines: 

  • To report provider services, use appropriate CPT* codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD-9-CM diagnostic codes.
  • CPT 20985 Computer-assisted surgical navigational procedure for musculoskeletal procedures; image-less (List separately in addition to code for primary procedure)

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Selected References: 

  • Leenders T, Vandevelde D, Mahieu G et al. Reduction in variability of acetabular cup abduction using computer assisted surgery: a prospective and randomized study. Comput Aided Surg. 2002; 7(2):99-106.
  • Sparmann M, Wolke B, Czupalla H et al. Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg Br. 2003 Aug;85(6):830-5.
  • Digioia AM 3rd, Jaramaz B, Plakseychuk AY et al. Comparison of a mechanical acetabular alignment guide with computer placement of the socket. J Arthroplasty. 2002 Apr;17(3):359-64.
  • Haaker RG, Stockheim M, Kamp M et al. Computer-assisted navigation increases precision of component placement in total knee arthroplasty. Clin Orthop Relat Res. 2005 Apr; (433):152-9.
  • Keene G, Simpson D, Kalairajah Y. Limb alignment in computer-assisted minimally-invasive unicompartmental knee replacement. J Bone Joint Surg Br. 2006 Jan; 88(1):44-8.
  • Hufner T, Meller R, Kendoff D et al. The role of navigation in knee surgery and evaluation of three-dimensional knee kinematics. Oper Techniq Orthop 2005; 15(1):64-9.
  • Stulberg SD, Loan P, Sarin V. Computer-assisted navigation in total knee replacement: results of an initial experience in thirty-five patients. J Bone Joint Surg Am 2002; 84-A Suppl: 90-8.
  • Schep NW, Broeder IA, van der Werken C. Computer-assisted orthopaedic and trauma surgery. State of the art and future perspectives. Injury 2003; 34(4):299-306.
  • Decking R, Markmann Y, Fuchs J et al. Leg axis after computer navigated total knee arthroplasty: a prospective randomized trial comparing computer-navigated and manual implantation. J Arthroplasty 2005; 20(3):282-8.
  • Hamelinck HK, Haagmans M, Snoeren MM, Biert J, Van Vugt AB, Safety of computer-assisted surgery for cannulated hip screws. Clin Orthop Relat Res. 2007 Feb;455-241-5.
  • Heffner T, Kendoff D, Citak M, Geerling J, Krettek C, Precision in orthopaedic computer navigation. Orthopade.2006 Oct;35(10)1043-55.

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New information or technology that would be relevant for Wellmark to consider when this policy is next reviewed may be submitted to:

Wellmark Blue Cross and Blue Shield
Medical Policy Analyst
Station 304
636 Grand Ave
Des Moines, Iowa 50309

*Current Procedural Terminology © 2009 American Medical Association. All Rights Reserved.

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