Anesthesia Coding Alert

These codes each represent 20 RVUs (relative value units). You receive payment for each level injected and documented, but remember that the multiple reduction guidelines apply.

The physician also uses fluoroscopy for needle placement; report this with 76005 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint], including neurolytic agent destruction) once per session. Code supervision and interpretation for each level with 72285 (Diskography, cervical or thoracic, radiological supervision and interpretation) or 72295 (Diskography, lumbar, radiological supervision and interpretation) as appropriate. No other fluoroscopy codes apply because diskography is considered an interventional component procedure and is solely diagnostic, says Trish Bukauskas-Vollmer, CPC, owner of TB Consulting in Myrtle Beach, S.C.

One challenge with diskography is getting reimbursed for all levels during a session. Bukauskas-Vollmer  recommends encouraging the physician to document each level in a separate paragraph of the patient's record. This makes it easy for you to distinguish levels when you're coding and for the carrier to understand the procedure when processing the claim.

Positive diskography results can lead to treatments such as those discussed below, so thorough documentation lays the groundwork for future coding.

Get Details for Disk Coding

When a disk herniates or ruptures, the nucleus comes out through a tear in the annulus and can compress a nerve root. This can happen on either side of the disk or on both sides, Bukauskas-Vollmer says.

Disk herniation doesn't usually happen overnight; the disks go through several stages before reaching that point. The more you know about the stages of herniation and the more specific the physician's diagnosis is, the more detailed your coding can be.

Example: If your only diagnosis is "herniated disk," your coding choice is 722.2 (Displacement of intervertebral disk, site unspecified, without myelopathy). But if the physician includes more details about the patient's condition and the areas affected, the more appropriate code could range from 722.0 (Displacement of cervical intervertebral disk without myelopathy) for cervical disk problems or 722.1x (Displacement of thoracic or lumbar intervertebral disk without myelopathy) for lumbar or thoracic conditions to one of the many choices from 839.xx (Other, multiple and ill-defined dislocations) for injury-induced dislocation or herniation.

Tip: Look for terms such as "degeneration," "prolapse," "extrusion" and "sequestration" that differentiate the various stages of disk herniation. Knowing this will help you code future procedures more accurately because treatment varies according to the different stages of disease, Bukauskas-Vollmer says.

Distinguish Nucleoplasty from IDET

Physicians have two techniques to decompress painful disks, but that doesn't mean you code them the same way.

Technique 1: Percutaneous diskectomy (also known as nucleoplasty) relieves pain by immediately decompressing the treated disk. Although this is a new technique, most coders do not have problems gaining prior authorization for this procedure if the patient meets treatment criteria. Patients considering nucleoplasty should know that researchers are still studying long-term outcomes of the procedure.

Code nucleoplasty with 62287 (Aspiration or decompression procedure, percutaneous, of nucleus pulposus of intervertebral disk, any method, single or multiple levels, lumbar [e.g., manual or automated percutaneous diskectomy, percutaneous laser diskectomy]). If the physician uses fluoroscopic guidance, include 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]).

If a second physician from your group provides anesthesia during the nucleoplasty, code his services with 00630 (Anesthesia for procedures in lumbar region; not otherwise specified).

Technique 2: Physicians also use IDET (intradiskal electrothermal therapy) to decompress painful disks. But successful IDET treatment decompresses the disk later, not immediately as in nucleoplasty. Medicare and many other carriers consider IDET to be an investigational procedure, which means it is not covered, says Barbara Johnson, CPC, MPC, president of Real Code in Moreno Valley, Calif. Because of this, Bukauskas-Vollmer recommends always obtaining precertification before scheduling IDET treatments.

CPT does not include a code for IDET, so report 64999 (Unlisted procedure, nervous system). If the carrier accepts HCPCS codes, you can report S2370 (Intradiskal electrothermal therapy, single interspace) and S2371 (Each additional interspace [list separately in addition to code for primary procedure]) instead.