Radiology Coding Alert

A new NCD spells trouble for certain guidance services, too.

Stop expecting Medicare to cough up payment for thermal intradiscal procedures or the guidance for them.

Here's why: On Dec. 8, CMS issued a national coverage determination (NCD) stating Medicare does not cover these thermal intradiscal procedures services.

The NCD instructs contractors to deny claims for thermal intradiscal procedures when billed using any of these codes: 22526-22527 (Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance ...) and 0062T-0063T (Percutaneous intradiscal annuloplasty,-any method except electrothermal, unilateral or bilateral including fluoroscopic guidance ...).

Contractors also must deny claims for the following codes when the narrative identifies the service provided as a thermal intradiscal procedure:

• 62287 -- Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method, single or multiple levels, lumbar (e.g., manual or automated percutaneous discectomy, percutaneous laser discectomy)

• 22899 -- Unlisted procedure, spine

• 64999 -- Unlisted procedure, nervous system.

And not only are the procedures noncovered, but payers must deny any fluoroscopic or radiologic guidance performed with them as well, according to the NCD, says Jay Neal, an Atlanta-based coding consultant.

What to do: "Providers are liable for charges if [a thermal intradiscal procedure] is used in surgery, unless the beneficiary was informed that he/she would be financially responsible prior to performance of the procedure. To avoid this liability the provider should have the beneficiary sign an ABN," the NCD states.

TIPs tip: In radiology, you're accustomed to seeing the acronym TIPS refer to transjugular intrahepatic portosystemic shunt. Don't get confused -- CMS refers to thermal intradiscal procedures also using the term TIPs, and those procedures are what the NCD covers.

To read the complete coverage decision, visit the CMS Web site at www.cms.hhs.gov/transmittals/downloads/R1646CP.pdf.