Anesthesia Coding Alert

Question: What procedure codes should we report for IDET (intradiscal electrothermal annuloplasty)?


Pennsylvania Subscriber

 
Answer: CPT Codes 2007 added two Category I codes for IDET: 22526 (Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level) and +22527 (... one or more additional levels [list separately in addition to code for primary procedure]).

Note that 22527 is for all additional levels, not each additional level. That means your coding and reimbursement for two levels is the same as for five.
 
Caution: Having specific codes, however, does not guarantee an easy road to reimbursement. Many carriers still consider IDET an investigational procedure, which means they won’t reimburse for the service. Documenting and submitting the claims--even if you might expect denial because of the investigational status--helps show the procedure’s frequency and potentially helps bolster the chances of reimbursement down the road.

Here’s how: Inform the patient prior to her procedure that her insurance might not cover IDET treatment. If she decides to proceed with the procedure, ask her to sign a waiver acknowledging that she might be responsible for payment if her carrier doesn’t cover the service.

For Medicare, you’ll complete an advance beneficiary notice (ABN). If the patient signs an ABN, append modifier GA (Waiver of liability statement on file) to the IDET codes to notify the carrier that you have a signed waiver on file. Other carriers might have their own notification forms, so follow their requirements.

If your physician performs IDET using something other than the electrothermal method, report 0062T (Percutaneous intradiscal annuloplasty, any method except electrothermal, unilateral or bilateral including fluoroscopic guidance; single level) and +0063T (... one or more additional levels [list separately in addition to 0062T for primary procedure]) as appropriate.

HCPCS note: Before CPT added codes for IDET, your only coding options for the procedure were S2370 (Intradiscal electrothermal therapy; single interspace) and S2371 (... each additional interspace). HCPCS deleted these codes in September 2004, so you should stick with the CPT options.