Anesthesia Coding Alert

Both procedures decompress disks, but that doesn't make them the same Many patients come to pain management clinics seeking relief from some type of spinal disk pain. Physicians have two techniques to decompress painful disks, but that doesn't mean you code them the same way -- or that carriers recognize them equally. Disk Decompression Is a Later-stage Treatment When conservative treatments such as physical therapy, medications or pain-relief injections fail, the next step toward relief for patients with contained herniated disks might be disk decompression. This can relieve discogenic low-back pain and radiculopathy associated with disk disease, says anesthesiologist Scott Groudine, MD, in Albany, N.Y. Patients who qualify for these treatments often have diagnoses such as:

Chronic low back pain (724.2 -- Lumbago)
Disk-related back pain (722.73 -- Intervertebral disk disorder with myelopathy; lumbar region, or 722.10 or 722.11 -- Displacement of thoracic or lumbar intervertebral disk without myelopathy)
Minimal leg pain (724.3 -- Sciatica)
Pain lasting longer than 3 months. Nucleoplasty Means Immediate Relief Percutaneous diskectomy (or nucleoplasty) immediately decompresses the treated disk and relieves pain. The physician inserts a transmitter that sends radio waves into the soft substance of the herniated disk.

Physicians perform nucleoplasty in an ASC or as a hospital outpatient service, which means you'll report either "22" or "24" for the type of service. Anesthesia during nucleoplasty usually consists of monitored anesthesia care (MAC) or conscious sedation. Successful nucleoplasty treatments can last for months or years. "I've seen some patients stay pain free for over two or three years," says Trish Bukauskas-Vollmer, CPC, owner of TB Consulting in Myrtle Beach, S.C. Authorize: Although this is a relatively new disk treatment technique, many coders do not have problems gaining prior authorization if the patient meets treatment criteria such as adequate documentation of failed conservative therapies and medical necessity. Diagnoses supporting medical necessity include 722.10 (Lumbar intervertebral disc without myelopathy), including disk herniation, radiculitis, extrusion, protrusion, prolapse, diskogenic syndrome and 722.52 (Lumbar or lumbosacral intervertebral disc), including narrowing of the disk space. Some carriers, however, still contend that the medical literature does not support the efficacy of nucleoplasty. Example: HGSAdministrators (a Pennsylvania Medicare carrier) issued a policy in 2003 stating that nucleoplasty (and all services associated with it) is considered a noncovered service. The policy instructs you to report code 22899 (Unlisted procedure, spine) for the procedure. If the carrier does not cover nucleoplasty but the patient wants to proceed, Groudine recommends having the patient sign an advanced beneficiary notice (ABN) waiver so the physician can be reimbursed for services. If the carrier approves nucleoplasty, report it with 62287 (Aspiration or decompression procedure, percutaneous, of nucleus pulposus of intervertebral disk, any method, single [...]