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Anesthesia Coding Alert

HCPCS Might Help With IDET Coding

Published on Sun Jun 01, 2003

Although intradiscal electrothermal therapy (IDET) doesn't have a specific CPT code (despite gaining U.S. Food and Drug Administration approval in 1998), you can still code the procedure accurately and receive proper reimbursement by thoroughly documenting medical necessity and knowing the ins and outs of all potential codes for IDET some of which you may not have considered before.

Document the Road to IDET

Before undergoing an IDET procedure, the patient must first be diagnosed with diskogenic pain (for example, 722.0-722.9x, Intervertebral disc disorders). Patients often deal with the pain for some time before receiving an official diagnosis, says Cecelia McWhorter, BA, CPC, an anesthesia and pain management coder with EmPhysis Medical Management Ltd. in Oklahoma City. For example, the patient may endure months or years of low back pain that radiates into his buttocks or tailbone but does not affect his leg. In time, the physician may take the next step to determine whether the patient has diskogenic pain.

The first step toward diagnosing diskogenic pain is magnetic resonance imaging (MRI, CPT 72148-Cpt 72149 and Cpt 72156-CPT 72158). The MRI shows whether the patient's disks have signs of wear and tear or degenerative changes. (Tears or fissures in the disk walls can become a source of chronic pain. The inner disk tissue can also herniate into the fissures, which increases the patient's discomfort.)

If the MRI shows disk changes, the physician might prescribe physical therapy to alleviate the pain. Other treatments may include pain management injections such as lumbar facet joint or facet joint nerve injections (64475-64476), lumbar/sacral transforaminal epidural injections (64483-64484), subarachnoid or epidural neurolytic injections/infusions (62280-62282), epidural or subarachnoid single injection (62311), or tendon or trigger point injections (20551-20552). Physicians often try these injections before opting for surgery or more serious actions to treat the patient's pain.

Patients who still have pain after these more conservative therapies will undergo diskography to make a definitive disk-related diagnosis. The anesthesiologist or a neurosurgeon places a needle in the patient's disk and creates pressure to represent the actual tension the disk is under when the patient sits or stands. The physician injects dye during the test to fill cracks and allow him or her to see disk tears or fissures.

A radiologist typically performs the diskography injection. But if the anesthesiologist performs it, McWhorter codes the procedure with either 62290* (Injection procedure for diskography, each level; lumbar) or 62291* ( cervical or thoracic), depending on the injection site. But she rarely uses 62291 because her physicians perform IDET almost exclusively in the lumbar region.

You should code the radiological supervision and interpretation of diskography with 72295 (Diskography, lumbar, radiological supervision and interpretation) and append modifier -26 (Professional component) if the anesthesiologist does not perform the diskography injection.

Search CPT for the Best IDET Code

Once the diskogram shows that one or two disks are damaged and causing pain, the physician considers IDET for treating the nucleus pulposus of the disk, McWhorter says. IDET is a minimally invasive outpatient procedure during which the physician applies heat to a section of the affected disk wall through a flexible catheter. The catheter generates heat that contracts and thickens the disk's collagen, which relieves the patient's pain by causing the fissures to close or contract.

Because CPT does not have a code specifically for IDET, different carriers may prefer different codes for the procedure. Potential CPT codes for IDET and its related procedures include:

  • 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). Trailblazer, a Medicare carrier in Delaware, Maryland, Texas and Virginia, suggests using 62287 for IDET, McWhorter says. "But it's best to keep an eye on your state's Medicare carrier's payment policies for IDET," she cautions. "We must not rely on manufacturer's code suggestions for procedures."
  • 76003 Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device). You should report 76003 for fluoroscopic guidance associated with 62287, CPT states. Some coders think 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) with modifier -26 (Professional component) describes the procedure better in this situation. But the National Correct Coding Initiative bundles 76005 into 62287, so be careful if you bill the two codes together.
  • 72295 Be sure to append this code with modifier -26 if the anesthesiologist reviews and interprets the results but does not perform the diskography.
  • 64999 Unlisted procedure, nervous system. Reporting "unlisted-procedure" codes for services is always risky because carriers prefer codes that describe the procedure more fully. But an unlistedprocedure code is sometimes your only option when the carrier in question doesn't accept the other CPT codes listed above for IDET.

    Append modifier -51 (Multiple procedures) to the applicable procedure code (such as those listed above) and include supporting documentation if the physician performs multiple injections during IDET.

    If the carrier denies surgical codes from an anesthesia provider, you should code IDET with the site-specific anesthesia code 00600 (Anesthesia for procedures on  cervical spine and cord; not otherwise specified), 00620 (Anesthesia for procedures on thoracic spine and cord; not otherwise specified), 00630 (Anesthesia for procedures in lumbar region; not otherwise specified) or 00300 (Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified).

    Some coders append modifier -52 (Reduced services) to the applicable anesthesia code. They argue that the codes infer open procedures and that IDET is a closed procedure. But others don't think this is necessary.

    "I don't know why anyone would want to show that any of the codes used for the procedure need to be paid at a reduced rate," McWhorter says. "I think this would be inappropriate and would signify that the catheter was being placed a second time when it isn't."

    When the carrier requires CPT codes and doesn't accept any of those listed above, report IDET with 01999 (Unlisted anesthesia procedure[s]).

    Don't Forget HCPCS Codes

    Most carriers prefer CPT codes, and coders rely on CPT for the bulk of their coding needs. But that doesn't mean you should ignore HCPCS codes especially when HCPCS added two codes specifically for IDET in 2001, says Cindy Parman, CPC, CPC-H, RCC, principal and co-founder of the consulting firm Coding Strategies in Dallas, Ga. The codes are:

  • S2370 Intradiscal electrothermal therapy, single interspace

  • S2371 Each additional interspace (list separately in addition to code for primary procedure).

    S codes describe drugs, services or supplies that are not included in CPT but are needed to make claims processing easier. Medicaid and some other carriers such as Blue Cross/Blue Shield of America and Health Insurance Association of America use S codes, but Medicare does not reimburse these services. Considering this, McWhorter recommends filing with the less-specific CPT codes for IDET instead of using HCPCS codes for Medicare claims or for other carriers that don't accept S codes.

    If the carrier accepts S codes from HCPCS, be sure to code IDET correctly based on the number of interspace injections, not disks treated. For example, if the physician injects three interspaces, code the procedure as S2370 and S2371 x 2.

    Whichever route you choose for IDET coding CPT or HCPCS S codes be consistent within the claim.  "From a CPT perspective, it's not correct to break down or unbundle a series of CPT codes for every step of the procedure when you're reporting to insurance carriers," McWhorter says. Use CPT codes or HCPCS S codes for all aspects of the claim, but not a combination of the two.

    Smooth the Process With Preapproval

    One thing that hasn't changed about coding for IDET since the procedure was introduced is the importance of preapproval. Some carriers including Medicare still consider IDET to be an investigational or experimental procedure, which means they often deny payment.

    "Preapproval will always be an issue as long as less specific codes are being used for procedures," McWhorter says. Her advice for helping IDET claims go through the system easily includes obtaining prior approval and filing the claim on paper instead of electronically. Then you can include a cover letter with an operative report and attach a description of the procedure with the claim.

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