Answer: Different carriers often observe different coverage and reimbursement guidelines. In this case, your local Medicare intermediary, Blue Cross/Blue Shield of Alabama, has listed 62287 (
Aspiration or decompression procedure, percutaneous, of nucleus pulposus of intervertebral disk, any method, single or multiple levels, lumbar [e.g., manual or automated percutaneous diskectomy, percutaneous laser diskectomy]) as an uncovered service since May 1, 2000, claiming, "The medical literature regarding this procedure shows it is not as effective as traditional methods," such as surgical diskectomy. Therefore, any claims for 62287 filed after May 1, 2000, would be denied as noncovered by the contract.
Note: The above policy is at the Blue Cross/Blue Shield of Alabama Web site: http://www.bcbsal.org/provider_pubs/provider/facts/PF0700.HTM.
Other carriers will cover
CPT 62287 a technique for decompression or removal of a symptomatic herniated lumbar disk with the use of a nucleotome (a blunt-tipped suction/cutting probe) in limited circumstances. For instance, Wisconsin Physicians Service, the Part B carrier for Wisconsin, Illinois, Michigan and Minnesota, will cover the procedure "for selected patients who have the physician and diagnostic imaging evidence that a single lumbar disc has an uncomplicated herniation that is contained within the annulus and they are a candidate for more invasive treatment because of the failure of medical management" with a diagnosis of
722.10 (
Lumbar intervertebral disc without myelopathy) or 722.51-722.52 (
Degeneration of thoracic or lumbar intervertebral disc).
Because of such differences in coverage, consult the payer first to determine if percutaneous diskectomy is a covered service and, if so, what diagnoses support medical necessity.
