Radiology Coding Alert

Question: I work for interventional radiologists who perform single and multi-level intradiscal electrothermal therapy (IDET) procedures. Do you have any tips on how to code IDET?

Oregon Subscriber

Answer: CPT does not include a specific IDET code, so many coders opt for 64999 (Unlisted procedure, nervous system) despite their hesitation to use "unlisted-procedure" codes.
 
If your payer accepts "S" codes, you can report HCPCS code S2370 (Intradiscal electrothermal therapy, single interspace) and then separately list add-on code S2371 (Each additional interspace) as appropriate.  
 
Typically, you will also need to report radiological supervision and interpretation along with the HCPCS codes. BlueCross BlueShield of Montana, for example, suggests 72285 (Diskography, cervical or thoracic, radiological supervision and interpretation) or 72295 (Diskography, lumbar, radiological supervision and interpretation), depending on which is appropriate.
 
And Regence BlueCross BlueShield of Oregon suggests 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) or 76003-26 (Professional component).
 
If you're coding for both the physician who performs the IDET and another who administers the anesthesia, you should report either 01991 (Anesthesia for diagnostic or therapeutic nerve blocks and injections [when block or injection is performed by a different provider]; other than the prone position) or 01992 (... prone position) for the anesthesia provider.
 
Many carriers still consider IDET an experimental procedure. Include notes supporting medical necessity to help increase your chances of reimbursement. Diagnoses that help justify IDET include 724.2 (Lumbago), 722.73 (Intervertebral disc disorder with myelopathy; lumbar region), 722.10-722.11 (Displacement of thoracic or lumbar intervertebral disc without myelopathy) and 724.3 (Sciatica). Remember that the patient must have pain for three months or longer before he is an IDET candidate.
 
IDET is a relatively new treatment for back pain caused by problems within the cushioning discs. This outpatient procedure is also called intradiscal electro-thermal annuloplasty. It applies high heat directly to the inside of the disc. While IDET is not as invasive or costly as spinal surgery, IDET is not always appropriate for people with lower-back pain.