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Neurology & Pain Management Coding Alert

READER QUESTIONS:

Lay Off Unlisted-Procedure Codes for IDET

Published on Sat Mar 19, 2005

Question: Recently, I filed a claim for intradiskal electrothermal therapy (IDET) using unlisted-procedure code CPT 64999 , but my claim came back without payment. Any suggestions?


California Subscriber


Answer: There are a couple of possible problems with your claim:

First, your coding is incorrect. Effective July 1, 2004, you should use one of two new codes to describe IDET:

  • 0062T - Percutaneous intradiscal annuloplasty, any method, unilateral or bilateral including fluoroscopic guidance; single level
  • +0063T - ... one or more additional levels (list separately in addition to 0062T for primary procedure).

    Prior to July 2004, you would have been correct to report 64999 (Unlisted procedure, nervous system) for most payers. Now, however, you should only use 64999 if your insurer specifically states it is incapable of processing Category III codes.

    Second, many insurers (including Medicare) still consider IDET to be experimental and will not pay for the procedure at all.

    If the insurer doesn't prohibit payment for IDET, you should include notes supporting medical necessity to help increase your chances of reimbursement. Diagnoses that help justify IDET include 724.2 (Lumbago), 722.73 (Intervertebral disk disorder with myelopathy; lumbar region), 722.10-722.11 (Displacement of thoracic or lumbar intervertebral disc without myelopathy) and 724.3 (Sciatica).

    Payers that will reimburse for IDET generally dictate that the patient must have pain for three months or longer before he is a candidate for IDET treatments.

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