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, [...]