# Lumbar Percutaneous Disc Decompression



## NESmith (Sep 14, 2011)

Please assist me in understanding this report. CPT code billed 62287 & 77003
Fluoroscopic evaluation of the lumbar region was undertaken. identification of the appropriate vertebral levels were identified and skin markings were placed.Area was prepped and draped in a sterile fashion with betadine on 3 separate occasions. Sterile towels were placed. the fluoroscopic image was obtained in an AP view and identification of the vertebral bosy and intervertebral disca were verified. the image was then rotated to the Right and the L5/S1 intervertebral disc space was noted, the end plates of the corresponding vertebral bodies were aligned and the image was rotated until the superior articulating process was in the mid portion of the corresponding intervertebral disc .2 cc's of 1% lidocaine was injected in the subcutaneous tissue using a 25 ga 1 1/2 inch needle. A 16 ga 7 inch introducer was placed withgentle manipulation under fluoroscopic guidance into the appropprate intradiscal space. Verification of needle placement was obtained and copy of which was placed on patients record an saved on the hard drive of the fluoroscopic machine, Zehiem. The needle was gently manipulated in the AP and lateral views until placement in the corresponding intervertebral disc space was noted. After confirmation of needle placement over the appropriate location, intradiscal, a solution of radio opaque contrast was injected while the patient was completely awake to light verbal stimuli. Stimulation to motor was performed to 2 mv and a negative motor response was noted. After placement of the needles the impedance was verified and the needles were stimulated to verify motor stimulation to 3 mv and no motor response was noted. Thermal lessoning was undertaken with 2 minute intervals of 60, 70, and 80 degree celsius was performed with the neurotherm preprogrammed RFA machine. At the conclusion of the procedure, a solution of 1 cc of 1% lidocaine and 10 mg of cefazolin was injected intradiscal. The procedure was repeated in the exact same dimensions above at the L5/S1level inclusive in the exact same dimensions described above. A total of 1 levels were performed. Fluoroscopic images were obtained and saved on the machines hard drive and a copy of which was placed on the patient's permanent office record. patient was alert to verabl and tactile stimuli during the entire procedure. The lumbar area was cleansed with a warm moist towel and the patient was taken to the recovery room in stable condition ambulating by self.
After doing some research and reading how the procedure is done, I am not sure this is what the provider did. Please give me your opinion and Thanks as always for your help.


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## dwaldman (Sep 14, 2011)

Thermal intradiscal procedure

"Thermal lessoning was undertaken with 2 minute intervals of 60, 70, and 80 degree celsius was performed with the neurotherm preprogrammed RFA machine. At the conclusion of the procedure, a solution of 1 cc of 1% lidocaine and 10 mg of cefazolin was injected intradiscal. The procedure was repeated in the exact same dimensions above at the L5/S1level inclusive in the exact same dimensions described above. "

Below is from the TIPs NCD found on CMS.gov that gives their stance _______________________________________________________________
Percutaneous thermal intradiscal procedures (TIPs) involve the insertion of a catheter(s)/probe(s) in the spinal disc under fluoroscopic guidance for the purpose of producing or applying heat and/or disruption within the disc to relieve low back pain.

The scope of this national coverage determination on TIPs includes percutaneous intradiscal techniques 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 probe(s)/catheter(s), which utilize a resistance coil or other delivery system technology, are flexible or rigid, and are placed within the nucleus, the nuclear-annular junction, or the annulus.

https://www.cms.gov/medicare-covera...ails.aspx?NCDId=324&ncdver=1&bc=AAAAQAAAAAAA&

Although not intended to be an all inclusive 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 coblation, or targeted disc decompression (TDD). At times, TIPs are identified or labeled based on the name of the catheter/probe that is used (e.g., SpineCath, discTRODE, SpineWand, Accutherm, or TransDiscal electrodes). Each technique or device has it own protocol for application of the therapy. Percutaneous disc decompression or nucleoplasty procedures that do not utilize a radiofrequency energy source or electrothermal energy (such as the disc decompressor procedure or laser procedure) are not within the scope of this NCD.


Indications and Limitations of Coverage 

B. Nationally Covered Indications

N/A

C. Nationally Non-Covered Indications

Effective for services performed on or after September 29, 2008, the Centers for Medicare and Medicaid Services has determined that TIPs are not reasonable and necessary for the treatment of low back pain. Therefore, TIPs, which include procedures that employ the use of a radiofrequency energy source or electrothermal energy to apply or create heat and/or disruption within the disc for the treatment of low back pain, are noncovered.

D. Other


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