Orthopedic Coding Alert

Question: A previous Orthopedic Coding Alert mentioned that CMS was considering coverage for thermal intradiscal procedures. Has there been any development?

Arizona Subscriber

Answer: CMS recently released its proposed decision memo for thermal intradiscal procedures -- or more accurately, its proposed noncoverage determination.

CMS "proposes that the evidence is adequate to conclude that thermal intradiscal procedures [TIPS] do not improve health outcomes. Therefore, CMS has determined that thermal intradiscal procedures are not reasonable and necessary for the treatment of low back pain and we propose to issue a national noncoverage determination for TIPs," according to the draft decision memo (www.cms.hhs.gov/mcd/viewdraftdecisionmemo.asp?id=215&).

Scope: According to CMS, the national coverage analysis (NCA) covers "TIPs which involve percutaneous intradiscal techniques utilizing devices that employ the use of an energy source, usually RFE, to apply or create heat within the disc for coagulation and/or decompression of disc material to treat symptomatic patients with annular disruption of contained herniated disc, to seal annular tears or fissures, or destroy nociceptors for the purpose of relieving pain."

What's not included: "Disc decompression or nucleoplasty procedures that involve the physical removal of disc tissue without the use of a thermal energy source (such as the disc decompressor procedure) as opposed to the vaporization of disc tissue, are not within the scope of this NCA," CMS states.