Musculoskeletal Assessment Systems

Number: 0212

Table Of Contents

Policy
Applicable CPT / HCPCS / ICD-10 Codes
Background
References

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Policy

Scope of Policy

This Clinical Policy Bulletin addresses musculoskeletal assessment systems.

1. Experimental and Investigational

   Aetna considers the following interventions experimental and investigational because the effectiveness or clinical value of these approaches has not been established:

   1. Use of the Metrecom skeletal analysis system or other computerized, biomechanical, or digital skeletal analysis systems because the value of this analysis in improving clinical outcomes is unproven. Individual components of these analyses are also considered experimental and investigational;
   2. FIGUR8 Advanced Musculoskeletal Assessment System for neuromuscular control screenings for injury prevention and rehabilitation.

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Table:

CPT Codes / HCPCS Codes / ICD-10 Codes

Code	Code Description
CPT codes covered if selection criteria are met:
Metrecom skeletal analysis - no specific code:
CPT codes not covered for indications listed in the CPB:
0778T	Surface mechanomyography (sMMG) with concurrent application of inertial measurement unit (IMU) sensors for measurement of multi-joint range of motion, posture, gait, and muscle function
95851	Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section (spine)
97750	Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes
ICD-10 codes not covered for indications listed in the CPB (not all-inclusive):
M00.00 - M99.9	Diseases of the musculoskeletal system and connective tissue
S00.00x+ - T14.91	Injury
Z13.820 - Z13.828	Encounter for screening for musculoskeletal disorders [for neuromuscular control screenings for injury prevention and rehabilitation]
Z13.850 - Z13.858	Encounter for screening for nervous system disorders [for neuromuscular control screenings for injury prevention and rehabilitation]

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Background

The Metrecom skeletal analysis system is a non-invasive, computerized electrogoniometer designed for postural evaluation, spinal analysis, and measurements of joint range of motion (ROM) and the Cobb angle.  It is designed to measure the entire expanse of the human body, in particular the osseous spatial arrangement of the spine, pelvis, upper and lower limb segments, in an X-Y-Z coordinate system.

This instrument consists mainly of a touch probe, a linkage arm with 6 angular displacement transducers, collectively known as a digitizer, and an IBM-compatible computer with a software package.  The system is actually a 3-dimensional (3-D) digitizer incorporating an electromechanical linkage arm having 3 joints comprised of 6 angular displacement transducers.  The arrangement of the 6 rotatory transducers allows the stylus point at the end of the linkage arm to move with 6 degrees of freedom; thus, it is able to reach any point in space within the range of the linkage arm.  The touch probe is placed on various palpated landmarks of the body, and readings of these landmarks, orientations, and positions are accomplished by means of a foot switch.  The computer then processes all this information and creates a 3-D image in its memory.  This image is then manipulated through various mathematical and engineering procedures to provide projections of various long bones on the 3 planes of the body.  The software creates a computer plumb line by which all the landmarks are referenced.  Both relative and absolute deviations from the plumb line are recorded for various clinically important landmarks and structures.

There is still considerable controversy regarding whether the Metrecom skeletal analysis system or other computerized/biomechanical/digital skeletal analysis systems provide accurate and reliable postural and vertebral analyses and measurements of ROM and the Cobb angle.  Further investigation is needed to ascertain the usefulness of these systems in the evaluation of musculoskeletal dysfunction, especially the rating of a disability or the grading of a recognized musculoskeletal disorder, as well as their contribution to treatment effectiveness and final health outcomes.

FIGUR8 Advanced Musculoskeletal Assessment System

FIGUR8 is a wearable motion analysis company.  Its Advanced Musculoskeletal Assessment System is a sensor fusion system combining inertial measurement system (IMU) and surface mechanomyography (sMMG), a proprietary technology developed by FIGUR8 for evaluation of muscle function and health.  sMMG sensors provide a novel way to quantify human movement.  When sMMG sensors are applied across the largest portion of a muscle they can record physical change in the muscles down to the 1/10 of a millimeter as muscle activation occurs, which allows for extrapolation of clinical feedback that results from the change in muscle shape during contraction.  The FIGUR8 movement platform uses proprietary sMMG sensor technology as a cornerstone in the 1st musculoskeletal diagnostics system of its kind that serves as a solution to clinicians and patients looking to accurately pinpoint the source of injury with access to real-time, quantifiable progress of a patient’s musculoskeletal health from the moment of injury to the moment of recovery.  The sensors are placed on the skin across the surface of a muscle to quantify muscle output, allowing clinicians to collect precise measurements regarding muscle performance and render data-driven decisions around clinical care, while providing important feedback to the individual patient.  The Advanced Musculoskeletal Assessment System supposedly enables a full musculoskeletal and orthopedic evaluation to be carried out in minutes.  In less than 15 minutes, the FIGUR8 System can deliver information regarding key musculoskeletal biomarkers including dynamic ROM, movement quality, strength and functional mobility in order to create an individualized and precise plan of care. 

However, there is a lack of peer-reviewed evidence regarding the clinical value of the FIGUR8 Advanced Musculoskeletal Assessment System.  Available data on the Advanced Musculoskeletal Assessment System are mainly abstracts from a single group of investigators.

Linderman et al (2020a) stated that neuromuscular control is an important factor for injury incidence and post-surgical rehabilitation.  Surface mechanomyography (sMMG) sensors are novel wearable devices that are applied over a muscle group to measure the physical output of muscle deformation resulting from a muscle contraction.  Electromyography (EMG) is the clinical standard for evaluating the electrical signal identifying muscle activation.  However, well-established data collection and analysis challenges limit the use of EMG for wide-spread neuromuscular control screening in a clinic setting.  These investigators examined the ability of sMMG sensors to detect timing patterns of muscle contraction and compare time events to those collected via conventional clinical EMG during a bilateral squat task.  A total of 11 healthy, active individuals (mean age of 30.0 ± 10.77 years, 7 males, 4 females) underwent a neuromuscular control assessment with EMG and sMMG sensors simultaneously applied to the right quadriceps.  Subjects carried out a series of 3 bilateral deep squats.  EMG data processed with a low-pass 6th order Butterworth filter and a TKEO function, and raw sMMG data were used for timing analyses.  Statistical analyses included paired t-test assessments between measurement modalities.  There was no significant difference (p = 0.985) in the timing of total duration of quadriceps contraction between EMG (mean = 2.526 ± 0.553 s) and sMMG (mean = 2.527 ± 0.539 s).  The duration of quadriceps contraction during the descent phase of the squat (eccentric contraction, p = 0.773) and the ascent phase (concentric contraction, p = 0.298) did not differ significantly between modalities.  The authors concluded that these findings were consistent with physiologic expectations that myoelectrical activity (measured by EMG) and the physical muscle deformation of muscles (measured by sMMG) occurred in extremely rapid succession.  Successful sMMG detection of quadriceps contraction was supported by similarity to EMG time signatures.  These results also suggested the ability of sMMG sensors to detect timing of activation for different types of muscle contraction during a functional exercise without the need for complex signal processing.  These researchers stated that sMMG sensor may be helpful in evaluating quadriceps muscle performance and timing as part of quick, in-the-clinic neuromuscular control screenings for injury prevention, rehabilitation, and exercise training.

Linderman et al (2020b) noted that efficient gastrocnemii force production is essential for performance of functional activities such as stair ascent/descent and athletic activities involving jumping or running.  Appropriate neuromuscular control and timing of gastrocnemius contraction is also important for fatigue and injury prevention.  Hand-held dynamometry (HHD) is the clinical standard for evaluating force production during a muscle contraction.  However, HHD is unable to provide precise timing data on the muscle activation responsible for force generation or monitor fatigue during an activity.  sMMG sensors are novel wearable devices that can be used across a muscle group to provide a measurement of physical muscle output during a contraction.  These researchers examined the relationship of sMMG’s muscle bulk displacement measurement to force generation and attempted to confirm sMMG detection of gastrocnemius contraction compared to the clinical timing standard of EMG.  Healthy, athletic individuals (mean age of 32.56 ± 10.57 years, n = 9, 7 males, 2 females) underwent a neuromuscular control assessment of the gastrocnemius.  Subjects carried out a series of 3 resisted “make-test” isometric holds with the right leg supported on an examination table and the ankle plantar flexed at 90 degrees against a hand-held dynamometer with simultaneous EMG and sMMG recording.  The 3rd trial was selected for analysis when available.  EMG data was processed with a 6th order low-pass Butterworth filter and a Teager-Kaiser energy operator function.  A threshold for detecting the time points of gastrocnemius activation and deactivation was set at 3 standard deviations (SDs) of a resting calibration trial above the minimum value for each measurement modality.  The relationship of sMMG signal output for physical muscle displacement was compared to muscle contraction force output via HHD and timing measured via EMG using paired t-tests and a Pearson correlation.  Peak gastrocnemius muscle bulk displacement detected by sMMG (mean = 7.65 ± 2.68 mm) positively correlated (r2 = 0.669) with maximum force generation detected by HHD during isometric contraction (mean = 58.43 ± 13.12 lb).  The duration of gastrocnemius muscle contraction during the isometric hold activity did not differ significantly (p = 0.273) between SMG (mean = 4.71 ± 1.17 s) and EMG (mean = 4.53 ± 1.17 s).  The authors concluded that correlation between HHD and sMMG supported the findings that increased physical muscle bulk displacement of the gastrocnemius was associated with greater force production during a contraction.  The similarity to EMG timing reinforced the ability of the sMMG sensor to consistently detect active gastrocnemius contraction without complex signal processing.  These researchers stated that sMMG sensors may be a useful measurement tool for evaluation of gastrocnemius functional performance during neuromuscular control screenings for injury prevention and rehabilitation.

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References