Friday, December 6, 2019

cpt 0335T. S2117 - Arthroereisis Procedure

Coding Code Description

CPT 0335T Extra-osseous subtalar joint implant for talotarsal stabilization

HCPCS

S2117 Arthroereisis, subtalar



Introduction

The talus bone is the bone in the foot that joins with the two leg bones. It is commonly called the ankle bone. The talus sits on top of the heel bone (calcaneus), and the joint between the talus and calcaneus is called the subtalar joint. This joint is quite complex because it’s responsible for moving the foot in several different directions. If this joint is too flexible, it could result in conditions known as flat feet and talotarsal dislocation. Having flat feet means that when the foot is on the ground there is no space between the middle of the foot — the arch — and the ground. All of the foot touches the ground. Talotarsal joint dislocation causes the middle of the foot to roll inward during walking. In surgery to restrict the movement of the subtalar joint, a small piece of metal is screwed into the naturally occurring small channel between the ankle bone and the heel bone. The implant keeps the subtalar joint from moving too much. The studies on this surgery are small and don’t show how well this procedure works over the long term. Published studies also report problems from the surgery and a high number of implants being removed after they were put in. For these reasons, subtalar arthroereisis is considered investigational (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

Subtalar arthroereisis Subtalar arthroereisis is considered investigational. Note: This policy only applies to subtalar arthroereisis (sinus tarsi implant or stent) surgery, a corrective operation to limit range of motion at the subtalar joint in cases of excessive mobility. Arthrodesis describes a surgical fusion of a joint so that the bones grow together. Subtalar arthrodesis (joint fusion) surgery is not addressed in this policy.



Description

Arthroereisis is a surgical procedure that purposely limits movement across a joint. Subtalar arthroereisis (STA) or extraosseous talotarsal stabilization is designed to correct excessive talar displacement and calcaneal eversion by reducing pronation across the subtalar joint. Extraosseous talotarsal stabilization is also being evaluated as a treatment of talotarsal joint dislocation. It is performed by placing an implant in the sinus tarsi, which is a canal located between the talus and the calcaneus.

Background

Flatfoot


Flexible flatfoot is a common disorder, anatomically described as excessive pronation during weight-bearing due to anterior and medial displacement of the talus. It may be congenital in nature, or it may be acquired in adulthood due to posterior tibial tendon dysfunction, which in turn may be caused by trauma, overuse, inflammatory disorders, and other factors. Symptoms include dull, aching pain, which in children may be described as growing pains. Additional symptoms include refusal to participate in athletics or walking long distances.

Treatment

Conservative treatments include orthotics or shoe modifications. Surgical approaches for painful flatfoot deformities include tendon transfers, osteotomy, and arthrodesis. Arthroereisis with a variety of implant designs has also been investigated.

Subtalar arthroereisis has been performed for more than 50 years, with a variety of implant designs and compositions. The Maxwell-Brancheau Arthroereisis (MBA) implant is the most frequently reported, although other devices such as the HyProCure, subtalar arthroereisis peg, and Kalix are also described in the medical literature. The MBA implant is described as reversible and easy to insert, with the additional advantage that it does not require bone cement. In children, insertion of the MBA implant may be offered as a stand-alone procedure, although children and adults often require adjunctive surgical procedures on bone and soft tissue to correct additional deformities.


Flatfoot

Arthroereisis is the limitation of movement across a joint. Subtalar arthroereisis (also called extraosseous talotarsal stabilization) is designed to correct excessive talar displacement and calcaneal eversion by reducing pronation across the subtalar joint.

Talotarsal Joint Dislocation

Extraosseous talotarsal stabilization is also being evaluated as a treatment of talotarsal joint dislocation. The stabilization procedure is performed by placing an implant in the sinus tarsi, which is a canal located between the talus and the calcaneus.

Summary of Evidence

For individuals who have flatfoot or talotarsal joint dislocation who receive subtalar arthroereisis (STA), the evidence includes mainly single-arm case series and a small nonrandomized controlled trial comparing STA with lateral column calcaneal lengthening. Relevant outcomes are symptoms, functional outcomes, and quality of life. The small nonrandomized comparative trial (N=24 feet) is considered preliminary, and interpretation of the case series evidence is limited by the use of adjunctive procedures in addition to STA, creating difficulties in determining the extent to which each modality contributed to the outcomes. Another limitation of the published data is the lack of long-term outcomes, which is of particular importance because the procedure is often performed in growing children. Also, some studies have reported high rates of complications and implant removal. The evidence is insufficient to determine the effects of the technology on health outcomes.

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