Orthopedic Coding Alert

Here's what to do if your MD performs these services for Medicare patients.

If you-ve got thermal intradiscal procedure payment woes, you shouldn't rely on 2009 to be the year CMS brings good news. You-ll need to pin your hopes on 2010 -- or later.

Earlier this year, CMS initiated a national coverage determination (NCD) regarding thermal intradiscal procedures, or TIPs, to determine whether these procedures should be payable. On Dec. 8, CMS decided to end the waiting game and issued an NCD on the topic.

According to the NCD, "the decision was made that TIPs are non-covered for Medicare beneficiaries."

What is TIPs? The term "TIPs" refers to percutaneous intradiscal techniques using devices that employ radiofrequency energy or electrothermal energy to create heat and/or disruption in the disc, according to the NCD. This description includes the following procedures, among others:

- Intradiscal electrothermal therapy (IDET)

- Intradiscal thermal annuloplasty (IDTA)

- Percutaneous intradiscal radiofrequency thermocoagulation (PIRFT)

- Radiofrequency annuloplasty (RA)

- Intradiscal biacuplasty (IDB)

- Percutaneous disc decompression (PDD) or ablation

- Targeted disc decompression (TDD).

"Not only are the TIPs procedures non-covered, but any fluoroscopic or radiologic guidance performed with the TIPs will be denied as well, according to the NCD," says Jay Neal, an Atlanta-based coding consultant.

Example: If your physician performs an IDET procedure (such as 22526, Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level), you should not expect any Medicare reimbursement.

Action: Have your Medicare patient sign an advance beneficiary notice (ABN). An ABN will protect your appeal rights and avoid loss of money on denied claims.

Other Payers May Consider Ban

Because other insurers tend to follow Medicare's lead regarding coverage decisions, it's possible that your private payers may start rejecting claims for TIPs as well. To avoid a nasty surprise, you should verify coverage of these procedures before your office schedules them.

"I am aware of at least two workers- compensation insurers that have been paying for IDET for about a year now," says Heather Corcoran, coding manager for CGH Billing in Louisville, Ky.

"I-ve told the practices that bill this procedure to keep an eye out for any potential coverage changes with those two payers," Corcoran advises. "This is probably good advice for anyone who bills these services."

  To read the complete coverage decision, go to www.cms.hhs.gov/transmittals/downloads/R1646CP.pdf.