Pain Management Coding Alert

Question: What is intradiscal electrothermal annuloplasty (IDET)? Our physician provided radiological guidance and completed the procedure. How can we report this service?

Florida Subscriber

Answer: You have not specified what type of radiological assistance your physician provides for IDET, but IDET usually is done under fluoroscopic guidance. This type of guidance is considered to be a part of the surgical procedure and not separately billable from 22526 (Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level) and +22527 (Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; 1 or more additional levels [List separately in addition to code for primary procedure]).

Reporting CT and MRI: You can sometimes separately report any other type of radiological guidance your physician used, but don’t assume that’s the case. If your physician actually performed the IDET, then he cannot bill separately for image guidance by either CT or MRI, as they are both included in procedure code. You can append a modifier to bypass the CCI edit, but you’ll need documentation that your physician used the image guidance for a different procedure during the same patient encounter not just with the IDET.

If you’re able to report guidance, submit code 77012 (Computed tomography guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], radiological supervision and interpretation) for CT. For MRI, you submit code 77021 (Magnetic resonance guidance for needle placement [e.g., for biopsy, needle aspiration, injection, or placement of localization device] radiological supervision and interpretation).

What is IDET? Intradiscal electrothermal annuloplasty (IDET) is a procedure where your physician adopts a percutaneous approach to place a specialized coil into the intervertebral disc annulus. This helps to firm up and stabilize the annulus fibrosus. The specialized “catheter” is heated to 90 degrees Celsius, which seals the fissures in the disc wall and ablates the small nerve endings that carry pain signals from the disc.

Check these codes: You report code 22526 for the first level of IDET. For any additional levels, you submit the add-on code +22527. You report only one unit of code +22527 irrespective of how many additional levels your physician treated after the initial one.