CPT 76120, 76125, 76496, 76499 - Dynamic spinal visualization

Coding Code Description CPT

76120 Cineradiography/videoradiography, except where specifically included

76125 Cineradiography/videoradiography to complement routine examination (list separately in addition to code for primary procedure)

76496 Unlisted fluoroscopic procedure (eg, diagnostic, interventional)

76499 Unlisted diagnostic radiographic procedure



Introduction

Dynamic spinal visualization is a way to see how the spine moves as a person bends or twists.

It’s thought that looking at moving images could help a healthcare professional diagnose the cause of neck or back pain or other problems with the spine. There are several different ways to create moving images as the spine twists or turns. Most techniques use x-ray to create images on film, a video monitor, or computer screen. Several x-rays are taken, assembled in order, and then played to create a moving image. Other technologies use fluoroscopy and MRI. Because there are not enough medical studies to show how well dynamic spinal visualization works, it’s considered unproven.

Note: The Introduction section is for your general knowledge and is not to be taken as policy coverage criteria. The rest of the policy uses specific words and concepts familiar to medical professionals. It is intended for providers. A provider can be a person, such as a doctor, nurse, psychologist, or dentist. A provider also can be a place where medical care is given, like a hospital, clinic, or lab. This policy informs them about when a service may be covered.


Policy Coverage Criteria


Service Investigational Dynamic spinal visualization (eg, The KineGraph VMA™)

The following dynamic spinal visualization techniques are considered investigational, including, but not limited to:
* Digital motion x-ray of the spine
* Cineradiography/videofluoroscopy
* Dynamic magnetic resonance imaging



Evidence Review Description

Dynamic spinal visualization is a general term addressing different imaging technologies that technologies have been proposed for the evaluation of spinal disorders including neck and back pain.

Background

Most spinal visualization methods use x-rays to create images either on film, video monitor, or computer screen. Digital motion x-ray involves the use of either film x-ray or computer-based xray “snapshots” taken in sequence as a patient moves. Film x-rays are digitized into a computer for manipulation, while computer-based x-rays are automatically created in a digital format.

Using a computer program, the digitized snapshots are then put in order and played on a video monitor, creating a moving image of the inside of the body. This moving image can then be reviewed by a physician, either alone or by using a computer, to evaluate several aspects of the body’s structure in order to determine the presence or absence of abnormalities. One use of this technology may be to examine intervertebral flexion and extension.

Videofluoroscopy and cineradiography are different names for the same procedure, which uses fluoroscopy to create real-time video images of internal structures of the body. Unlike standard x-rays, which take a single picture at one point in time, fluoroscopy provides motion pictures of the body. The results of these techniques can be displayed on a video monitor as the procedure is being conducted, as well as recorded, to allow computer analysis or evaluation at a later time.

Like digital motion x-ray, the results can be evaluated by a physician alone or with the assistance of computer analysis software.

Dynamic magnetic resonance imaging (MRI) is also being developed for imaging of the cervical spine. This technique uses an MRI-compatible stepless motorized positioning device (NeuroSwing, Fresenius/Siemens) and a real-time true fast imaging with steady-state precession sequence to provide passive kinematic imaging of the cervical spine. The quality of the images is lower than a typical MRI sequence, but is proposed to be adequate to observe changes in the alignment of vertebral bodies, the width of the spinal canal, and the spinal cord. Higher resolution imaging can be performed at the end positions of flexion and extension.

Summary of Evidence

For individuals who have back or neck pain who receive dynamic spinal visualization, the evidence includes comparative trials. Relevant outcomes are test accuracy, symptoms, and functional outcomes. Techniques include digital motion x-rays, cineradiography/ videofluoroscopy, or dynamic magnetic resonance imaging of the spine and neck. The available  studies compare spine kinetics in patients with neck or back pain to that in healthy controls. Noliterature was identified on the diagnostic accuracy of dynamic visualization in a relevant patient population. No evidence was identified on the effect of this technology on symptoms or functional outcomes. The evidence is insufficient to determine the effects of the technology on health outcomes.

According to Hayes, there is insufficient published evidence to assess the safety and/or impact on health outcomes or patient management for the use of Vertebral Motion Analysis for assessing spinal instability. (Hayes 2017) Practice Guidelines and Position Statements No guidelines or statements were identified.

Medicare National Coverage

There is no national coverage determination (NCD). In the absence of an NCD, coverage decisions are left to the discretion of local Medicare carriers.

Regulatory Status

In 2012, The KineGraph VMA™ (Vertebral Motion Analyzer, Ortho Kinematics) was cleared for marketing by the U.S. Food and Drug Administration (FDA) through the 510(k) process. The system includes a Motion Normalizer™ for patient positioning, standard fluoroscopic imaging, and automated image recognition software. Processing of scans by Ortho Kinematics is charged separately.

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