Orthopedic Coding Alert

Intradiscal Electrothermal Annuloplasty (IDET) is a minimally invasive, outpatient procedure used to treat lower back pain. Although approved by the FDA in 1998, IDET is still regarded by many carriers as experimental. While more carriers are reimbursing for IDET, their guidelines for claim submission vary significantly and, in some cases, run contrary to correct coding. Preauthorization and prospective negotiation of reimbursement are necessary for any carrier that will reimburse for IDET.
Alternative to Surgery
Chronic back pain can be caused by small disc herniations, internal disc tears or mild disc degeneration. IDET follows a diagnosis of 722.0-722.9 (intervertebral disc disorders), which is usually concluded via an MRI and diskography. IDET is usually the next step after a series of oral pain medications, therapeutic injections and/or physical therapy.
   
Under local anesthesia and with x-ray guidance, a catheter is inserted into the painful lumbar disc space. Heat is introduced via the catheter, which is advanced along the annulus of the disc. The heat of the catheter cauterizes the nerve endings and shrinks collagen fibers and tissue to strengthen the area. Proponents of IDET consider it a safer, less expensive alternative to more invasive spinal surgery, which carries greater risks for intra- and postoperative complications.
Many Code Combinations
There are several different code combinations to use when reporting the procedure. Because no CPT code exists to describe the procedure, most carriers require one of two unlisted-procedure codes, 22899 (unlisted procedure, spine) or 64999 (unlisted procedure, nervous system). While HCPCS has two recommended S codes for IDET, Medicare policy specifically states that these temporary codes are not payable. However, some private carries prefer the S codes to the CPT unlisted-procedure codes:
  S2370 intradiscal electrothermal therapy, single interspace
  S2371 each additional interspace (list separately in addition to code for primary procedure).
Despite the HCPCS Codes , some Medicare carriers require CPT Codes to report IDET. For example, Arkansas Blue Cross Blue Shield (BCBS), the Part B carrier for several southern states, requires that CPT 64999 be reported for IDET. HGSA (formerly Xact), the local Medicare Part B carrier for Pennsylvania, requires 22899.
 
Other coders report success with 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]) or 64622-64623 (destruction by neurolytic agent, paravertebral facet joint nerve ...). Some carriers will accept codes for fluoroscopy and catheterization in addition to the codes for the major procedure. Jessica Kibbe, CPC, coder/biller for Foundation Surgery Affiliates, an ambulatory surgical center in Houston, uses the following coding [...]