Anesthesia Coding Alert

Our experts provide surefire strategies for working with carrier policies 

If your pain management specialist performs intradiscal electrothermal annuloplasty (IDET) procedures, your coding options have been extremely limited -- until this year.

CPT Codes 2007 includes two new codes for IDET and modified versions of the Category III codes you previously relied on -- but that doesn’t mean automatic payer reimbursement. Get the scoop from some of our experts on how to handle the latest IDET claims.

Check Your Coding Options

Your first step toward correctly coding IDET procedures is to recognize the associated terminology. The name “IDET” includes a range of procedure names, including intradiscal electrothermal annuloplasty, IDEA, percutaneous annuloplasty, and electrothermal coagulation. 

Procedure low-down: IDET is a minimally invasive surgical procedure to treat chronic low-back pain related to disc disease (particularly disc degeneration), says Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.
 
The physician uses a needle to insert a flexible catheter in the damaged disc. The physician then heats the catheter (usually with radiofrequency energy) to treat nerve/pain fibers and shrink and stabilize collagen fibers within the disc.

CPT’s new IDET codes are:

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

• +22527 -- ... one or more additional levels (list separately in addition to code for primary procedure).

CPT’s updated Category III codes for IDET are:

• 0062T -- Percutaneous intradiscal annuloplasty, any method except electrothermal, unilateral or bilateral including fluoroscopic guidance; single level

• +0063T -- ... 1 or more additional levels (list separately in addition to 0062T for primary procedure).

Pay attention: Unlike many pain management procedures, CPT’s new and updated IDET codes include using fluoroscopic guidance. Consequently, do not report 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) or 77003 (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) during an IDET procedure.
 
“Often, these little details get missed,” Hammer says. “Out of habit, we mark the [fluoroscopic guidance] codes on charge tickets, and they get coded and billed.”

What happens next: If you report fluoroscopic guidance codes with the IDET procedure codes, get ready for denials. “Billing for separate items in a comprehensive code will result in denial once it’s recognized -- at best -- and could trigger other audits to look for examples of unbundling,” says Scott Groudine, MD, an anesthesiologist in Albany, N.Y.

Keep Alert for Carrier Updates

Many carriers won’t reimburse for IDET because they still consider it to be an experimental procedure. Many workers’ compensation payers and some auto injury payers, however, do authorize and reimburse for disc annuloplasty procedures.

Other carriers (such as Regency Blue Cross Blue Shield and Blue Cross Blue Shield of California) have updated their policies because of the code changes but continue their position of non-coverage due to the procedure’s investigational nature.

“Several, but not all, Medicare carriers had LCDs [local coverage determinations] taking a non-coverage stance for the Category III codes for IDET,” Hammer says. “To date, there have been no updates for the new 2007 Category I codes.”

What it means: Watch your Medicare carrier’s position on IDET coverage so you know how to handle the claims.
 
Medicare doesn’t usually pay for this, so having a Medicare patient sign an advance beneficiary notice (ABN) is a good idea if you offer IDET to him, Groudine says. “Using ABNs has two major benefits,” he says. “It protects your appeal rights, and you avoid loss of money for denied claims. Without an ABN, you might not be able to collect for your services.”

If you do provide patients with an ABN, be sure it completely documents the situation. Otherwise, you still might not receive payment even if you have the ABN. 
  
Example: The Kansas Medicare Web site includes this question and answer regarding ABNs:

Question: Am I protected from having to pay if I did not receive an ABN or if there is something wrong with the ABN that I received?

Answer (in part): Yes. … If a physician, provider or supplier fails to give an ABN or gives a defective ABN, the beneficiary probably will be protected from financial liability for the cost of the service or item. 

Watch for Future Reimbursement

Although you might not get consistent IDET reimbursement today, having CPT codes should be a step toward helping change that in the future.

“Having Category I codes with published RVU valuations will certainly help with those payers that do cover the procedure,” Hammer says. “It will allow their computer systems to auto-adjudicate the claims rather than manually processing the allowable amount for the non-valued Category III codes.

“Most Medicare carriers will have addendums or updates to their previous LCD within the first quarter when the new codes are implemented,” Hammer says. “Commercial carriers usually take a longer period of time to update their policies.”

Bottom line: Even if your carriers don’t recognize IDET now, experts often say that having Category III codes in CPT helps carriers move in that direction. Stay up-to-date on your carriers’ stance regarding IDET, submit claims with supporting documentation, and someday your provider might reap the rewards.