April 2006, Part 1: Position Statement on Image Guidance

Michael Setzen, MD, FACS
Chairman, Patient Advocacy Committee,

As Chair of the Patient Advocacy Committee I am frequently asked to respond to issues related to the unfair business practices of insurance carriers. It is apparent to me that these unfair practices are pervasive throughout the specialty and the country and each and every carrier unleashes this unfair practice on members of the ARS and the American Academy of Otolaryngology-Head and Neck Surgery.

Of the many calls and e-mails I have received, it is apparent to me that more problems appear to be occurring in the Northeast with the worst offender being Blue Cross/Blue Shield.

The ARS welcomes the opportunity to assist in problems related to Rhinology, but it is our policy to assist only members of the ARS. For this reason I would suggest otolaryngologists doing a significant proportion of Rhinology, seriously consider joining the ARS.

On a more positive note, the Board of Directors of the American Academy of Otolaryngology- Head and Neck Surgery at its most recent Board meeting in Los Angeles (September 28th,2005), revised its position statement on computer-aided surgery.

This was at the request of the Rhinology and Paranasal Sinus Committee of the Academy following a recommendation of the ARS.

The revisions make note of the fact that "the American Academy of Otolaryngology- Head and Neck Surgery endorses the intraoperative use of computer-aided surgery in appropriate select cases to assist the surgeon in clarifying complex anatomy during sinus and skull base surgery."

This statement is important because it states that image guidance surgery is only necessary in the more complex cases of nasal and sinus surgery, in particular when involving the skull base, revision surgery, or sphenoid, frontal, and posterior ethmoid sinus disease.

"There is sufficient expert consensus opinion and literature evidence base to support this position." This is an important inclusion in the position statement as many insurance carriers are denying reimbursement for image guidance surgery based on the fact that they claim there is insufficient expert opinion and insufficient literature to support its use.

"This technology is used at the discretion of the operating surgeon." This is another important addition to the position statement because it lets it be known that this technology is state of the art, but by no means standard of care and that the use of this technology is at the discretion of the operating surgeon based on the type of case at hand.

"It is not experimental or investigational." This is an extremely important addition since once again many third party payers are denying reimbursement claiming that this is indeed experimental and investigational.

"The Academy of Otolaryngology-Head and Neck Surgery is of the opinion that it is impossible to corroborate this with level one evidence." This statement lets it be known that level one evidence can never be shown to prove the importance of image guidance surgery. This cannot be corroborated with level one evidence because it would be unethical to do a double-blind study in which half the patients would be operated on without image guidance. Furthermore 30,000 plus patients would be needed in this double-blind study and this would be impossible to carry-out.

I highly recommend that when image guidance is denied reimbursement that a copy of the new position statement be included with your letter of denial: http://www.entnet.org/Practice/policyIntraOperativeSurgery.cfm.

A special thanks to the Board of Directors of the American Academy of Otolaryngology-Head and Neck Surgery for making these important changes to the position statement for computer-aided surgery in Otolaryngology.

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Original Article 4/2006
Revised 6/2011
©American Rhinologic Society