# Help  New to this- Confussed



## PRHODES (Apr 11, 2015)

Hi , I am new to this - not sure where to start..

Procedure Note

1 L5-S1 Discectomy
2. L5-Sl Annuloplasty
3. L5-S1 Discogram 

Dx - 1. L5-S1 disc herniation
2. L5-S1 Annular tear
3. Lumbar Pain
4. Lumbar radiculopathy


would procedure code 62287 , 62290? Is the discogram included in procedure or do you bill this also with 58 modifier? cpt code 72295 Cpt code 22526 for Annuloplasy ?

Any help will be greatly appreciated 
Thank you

Pat R


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## dwaldman (Apr 13, 2015)

62287 Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization, with the use of an endoscope, with discography and/or epidural injection(s) at the treated level(s), when performed, single or multiple levels, lumbar 

22526 Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level 


_______________________________________________________

CPT 62287 includes discography (62290 72295) as seen in the descriptor above.

CPT 22526 falls under a NCD/National Coverage Determination policy by Medicare that it is not covered. They state the radiological or fluoroscopic guidance utilized would also be non-covered. And this would include CPT 62290 72295.

Below is the Medicare NCD for thermal intradiscal procedures. The NCD did copy and paste with multiple spaces, but I tried to include it.  I would look at the carrier you are billing and look at their policy for CPT 22526.




States Affected  NA  
Policy Number  150.11   
Subject  Thermal Intradiscal Procedures (TIPs)    





NCD for Thermal Intradiscal Procedures (TIPs)150.11 per CMS Transmittal R97NCD



Disclaimer:  Transmittal R97NCD will be used as a reference to represent NCD 150.11 in order to provide Advanced Beneficiary Notice requirement guidance, until CMS has provided official resource documentation of the NCD on their website









CMS Manual System 

Department of Health & 

Human Services (DHHS) 


Pub 100-03 Medicare National Coverage Determinations 

Centers for Medicare & Medicaid Services (CMS) 


Transmittal 97 

Date: December 9, 2008 


Change Request 6291 




Subject: Thermal Intradiscal Procedures (TIPs) 





I. SUMMARY OF CHANGES: Upon completion of a national coverage analysis for TIPS, the decision was made that TIPs are non-covered for Medicare beneficiaries. The addition of ? 150.11 of Pub.100-03 is a national coverage determination (NCD). NCDs are binding on all carriers, fiscal intermediaries, quality improvement organizations, qualified independent contractors, the Medicare Appeals Council, and administrative law judges (ALJs) (see 42 CFR section 405.1060(a)(4) (2005)). An NCD that expands coverage is also binding on a Medicare advantage organization. In addition, an ALJ may not review an NCD. (See section 1869(f)(1)(A)(i) of the Social Security Act.) 



New / Revised Material 

Effective Date: September 29, 2008 

Implementation Date: January 5, 2009 



Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents. 





II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated) 

R=REVISED, N=NEW, D=DELETED-Only One Per Row. 






1/150/150.11/Thermal Intradiscal Procedures (TIPs) (Effective September 29, 2008) 



III. FUNDING: 

 SECTION A: For Fiscal Intermediaries and Carriers: 

No additional funding will be provided by CMS; Contractor activities are to be carried out within their operating budgets. 


SECTION B: For Medicare Administrative Contractors (MACs): 

The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements. 

IV. ATTACHMENTS: 



Business Requirements 

Manual Instruction 


*Unless otherwise specified, the effective date is the date of service. 

 Attachment - Business Requirements 


Pub. 100-03 

Transmittal: 97 

Date: December 9, 2008 

Change Request: 6291 




SUBJECT: Thermal Intradiscal Procedures (TIPs) 

Effective Date: September 29, 2008 

Implementation Date: January 5, 2009 





I. GENERAL INFORMATION 



A. Background: This is a new national coverage determination (NCD). There is no existing NCD on thermal intradiscal procedures (TIPs). 



On January 15, 2008, the Centers for Medicare and Medicaid Services (CMS) initiated a national coverage analysis (NCA) on (TIPs). The scope of this NCA on TIPs included percutaneous intradiscal techniques utilizing devices that employ the use of a radiofrequency energy source or electrothermal energy to apply or create heat and/or disruption within the disc for coagulation and/or decompression of disc material to treat symptomatic patients with annular disruption of a contained herniated disc, to seal annular tears or fissures, or destroy nociceptors for the purpose of relieving pain. This includes techniques that use single or multiple probes/catheters, which utilize a resistance coil or other thermal intradiscal technology, are flexible or rigid, and are placed within the nucleus, the nuclear-annular junction or the annulus. Although not meant to be a complete list, TIPs are commonly identified as intradiscal electrothermal therapy (IDET), intradiscal thermal annuloplasty (IDTA), percutaneous intradiscal radiofrequency thermocoagulation (PIRFT), radiofrequency annuloplasty (RA), intradiscal biacuplasty (IDB), percutaneous (or plasma) disc decompression (PDD) or ablation, or targeted disc decompression (TDD). At times, TIPs are identified or labeled based on the name of the catheter(s)/probe(s) that is used (e.g. SpineCath, discTRODE, SpineWand, Accutherm, or TransDiscal electrodes). This change request (CR) communicates the findings and the NCD of this NCA. 



While four CPT codes are identified for TIPs procedures performed within the annulus of the intervertebral disc (22526, 22527, 0062T and 0063T), the codes (codes 62287, 22899 and 64999) used for TIPs procedures performed within the nucleus of the disc (eg., PDD or TDD procedures) may also be used for procedures that are not within the scope of the TIPs NCD. The contractors may advise providers through a MLN Matters article to submit TIPs procedures performed within the nucleus under code 22899 or 64999 with a clear description of the procedure in the narrative section of the claim since these codes suspend for review. Contractors may also advise providers to submit the biacuplasty procedure under code 0062T (currently some providers are submitting this procedure under code 64999). This CR provides instructions on codes that shall be denied when submitted and for codes that shall be denied when identified as a TIP. 



All TIPs procedures are performed with radiologic or fluoroscopic guidance. This service would be directly related to a noncovered service and, therefore, noncovered. This CR provides an instruction to deny claims for the radiologic or fluorosocpic guidance when performed in conjunction with a TIP. 



This CR includes requirements for physicians and hospitals to provide appropriate liability notices to beneficiaries. Any provider who performs the service described in this instruction that is expected to be non-covered on the basis of this coverage decision should provide the beneficiary with the appropriate liability notice in advance of the procedure consistent with chapter 30, Pub 100-04, the Medicare Claims Processing. 





B. Policy: Effective for services performed on or after September 29, 2008, CMS has concluded that the evidence does not demonstrate that TIPs improve health outcomes. Thus, CMS has determined that TIPs are not reasonable and necessary for the treatment of low back pain. Therefore, TIPs are noncovered as identified in section 150.11 of Pub.100-03, the NCD Manual.


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## PRHODES (Apr 16, 2015)

Thank you so much for your help


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