Orthopedic Coding Alert

Selective endoscopic diskectomy (SED) is a relatively new spinal procedure used to treat herniated disks. Proponents view SED as a less invasive treatment of herniated lumbar disks, and a better alternative to fusion for many cases of chronic back pain. SED allows the orthopedist to see the surgical site via the scope before excising the disk material.

Although clinical studies have proven its efficacy, coding and reimbursement are not yet up to speed. Correct coding and optimal payment involve educating the carrier(s), documenting the procedure and agreeing in advance to reimbursement levels with major carriers.

Clinical Example

Sherry Zeagler, director of clinical and ancillary services at The Louisiana Clinic, a multispecialty practice in New Orleans, provides an SED operative report for interpretation:

The patient, a middle-aged female, was diagnosed with a recurrent L4-L5 lumbar disk herniation (722.10 , displacement of lumbar intervertebral disk without myelopathy) and was placed under local anesthesia so she could respond to questions during surgery.

The L4-L5 area was injected with dye, and several intraoperative x-rays were taken as a needle was advanced into the region. When the surgeons determined the proper location of the needle, a guidewire with a dilator was inserted as the needle was removed. A cannula was inserted in place of the dilator, and an endoscope (discoscope) was advanced through the cannula, allowing the surgeon to visualize fully the affected lumbar region. Through the endoscope, the area was punched and shaved to remove the disk. The patient, conscious throughout the entire procedure, was asked to evaluate her leg and back pain, and reported that it had totally dissipated. A minimal incision, negligible blood loss and lack of general anesthesia contributed to the patients minimal recovery time, and she was released later the same day.

Unfortunately, coding SEDs correctly and ensuring reimbursement is not an easy task. Because no CPT Code describes an SED, coders should anticipate using an unlisted procedure code when submitting a claim. Choices are 29909 (unlisted procedure, arthroscopy) or 64999 (unlisted procedure, nervous system). According to Eric Sandham, CPC, compliance educator of the Central California Faculty Medical Group in Fresno, Calif., either code will have the same result. Both codes will spit the claim out of automatic processing for manual pricing. If the coder doesnt submit an operative report, the carrier will request one, Sandham says.

Coders should include the operative report and a brief letter from the surgeon explaining in lay terms what he or she did in the operating room. In the letter, the surgeon should cite an analogous code (in the [...]