Neurology & Pain Management Coding Alert

Answer: Intradiscal electrothermal annuloplasty, also called intradiscal electrothermal therapy (IDET), is a relatively new treatment (introduced in 1997) for back pain in which the physician applies high heat directly to the inside of the vertebral disc. The procedure is less expensive and less invasive than spinal surgery and, according to an American Academy of Orthopaedic Surgeons fact sheet, is usually reserved only for patients who have unsuccessfully tried aggressive, nonoperative techniques to relieve their pain.

 CPT has no specific code to describe this procedure. CPT and AMA guidelines dictate, "Do not select a CPT code that merely approximates the service provided. If no such procedure or service exists, then report the service using the appropriate unlisted-procedure or -service code." Therefore, your best choice for this procedure is unlisted-procedure code 22899 (Unlisted procedure, spine) or 64999 (Unlisted procedure, nervous system). HCPCS does contain two temporary codes to describe IDET S2370 (Intradiscal electrothermal therapy, single interspace) and S2371 ( each additional interspace [list separately in addition to code for primary procedure]) and some insurers may accept these codes, but you'll want to confirm this prior to billing.

 Medicare payers will not reimburse for this procedure because peer-reviewed data lack evidence of effectiveness, safety and long-term results.