Health Evidence Review Commission's Value-based Benefits Subcommittee

significant new evidence has been found. Gibson suggested reviewing shorter course
radiation therapy for breast cancer in situ. Pollack suggested reviewing personalized
medicine/gene tests for targeted drug therapy. Staff reported that many of these types
of tests are going to be reviewed through the coverage guidance process, and therefore
this topic does not need to be part of the biennial review.
3) The publication of errata continues, and the most recent errata was summarized in the
packet.
4) The statewide back pain guidelines will be retired with HERC approval. The coverage
guidances resulting from these guidelines will continued to be maintained and updated.
5) Staff has identified that diaphragmatic hernia with obstruction or gangrene diagnosis
codes have been separated from their treatment CPT codes. Staff will move the ICD-10
diagnosis codes for these conditions to the upper GERD line where the CPT codes reside
as an errata, and bring back the issue for more definitive discussion in March. The
subcommittee agreed with this plan.
‣ Topic: Straightforward/Consent Agenda
Discussion: There was no discussion about the consent agenda items.
Recommended Actions:
1) Add 50948 (Laparoscopy, surgical; ureteroneocystostomy without cystoscopy and
ureteral stent placement) to line 184 URETERAL STRICTURE OR OBSTRUCTION;
HYDRONEPHROSIS; HYDROURETER
2) Add 47535 (Conversion of external biliary drainage catheter to internal-external
biliary drainage catheter, percutaneous, including diagnostic cholangiography when
performed, imaging guidance (eg, fluoroscopy), and all associated radiological
supervision and interpretation) to line 320 CANCER OF LIVER
3) Add 47534-47536 (Placement/conversion/ exchange of biliary drainage catheter,
percutaneous) to line 84 INJURY TO INTERNAL ORGANS
4) Add 27130 (Arthroplasty, acetabular and proximal femoral prosthetic replacement
(total hip arthroplasty), with or without autograft or allograft) to line 205 CANCER
OF BONES
5) Modify guideline note 65 as shown in Appendix A
6) Delete guideline note 16 as shown in Appendix C
MOTION: To approve the recommendations stated in the consent agenda. CARRIES 6-0.
(Absent: Allen)
Value-based Benefits Subcommittee Minutes, 1/14/2016 Page 4