Neurosurgery Coding Alert

Document benefits of treatment and impact on clinical management. 

A Jan. 14, 2014, decision memo from CMS announced that “percutaneous image guided lumbar decompression (PILD) for lumbar spinal stenosis (LSS) is not reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act.” 

What does this announcement mean for you? This announcement implies that Medicare will only cover PILD under certain conditions. Let’s take a quick look at conditions where your Medicare beneficiaries can benefit. 

Check Your PILD Study Protocols

The decision memo noted CMS will cover PILD for Medicare patients when the treatment is provided in a clinical study “under section 1862(a)(1)(E) through Coverage with Evidence Development (CED) for beneficiaries with LSS who are enrolled in an approved clinical study.” The study must meet several criteria, including specifying a statistical analysis and a minimum length of patient follow-up time that evaluates the beneficial effects of treatment and the duration of benefit.

The study must analyze and answer three questions, according to CMS:

• Does PILD provide a clinically meaningful improvement of function and/or quality of life in Medicare beneficiaries with LSS compared to other treatments?
• Does PILD provide clinically meaningful reduction in pain in Medicare beneficiaries with LSS compared to other treatments?
• Does PILD affect the overall clinical management of LSS and decision making, including use of other medical treatments or services, compared to other treatments?

Resources: To read the entire decision and criteria for coverage, visit www.cms.gov and search for “decision memo PILD.” To learn more about PILD and its possible coding, see “Payment Update: Check Medicare Policy When Reporting Percutaneous Image-guided Lumbar Decompression” in Neurosurgery Coding Alert, Vol. 15, Number 2.

If you’re able to report the PILD procedure, submit the Category III code 0275T (Percutaneous laminotomy/laminectomy [interlaminar approach] for decompression of neural elements, [with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy], any method, under indirect image guidance [e.g., fluoroscopic, CT], with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; lumbar). You submit this code when your surgeon adopts a percutaneous fluoroscopic or endoscopic approaches for a unilateral or bilateral laminotomy or laminectomy to decompress the neural elements. Your surgeon may attempt the procedure under fluoroscopic or CT imaging guidance, and the procedure may be done with or without ligamentous resection, discectomy, facetectomy, or foraminotomy. Essentially, this surgical procedure increases the amount of space available for the nerve roots passing in the spinal canal, thus relieving painful pressure on the nerve(s).