Anesthesia Coding Alert

Although intradiscal electrothermal therapy (IDET) doesn't have a specific CPT code (despite gaining U.S. Food and Drug Administration approval in 1998), you can still code the procedure accurately and receive proper reimbursement by thoroughly documenting medical necessity and knowing the ins and outs of all potential codes for IDET some of which you may not have considered before. Document the Road to IDET Before undergoing an IDET procedure, the patient must first be diagnosed with diskogenic pain (for example, 722.0-722.9x, Intervertebral disc disorders). Patients often deal with the pain for some time before receiving an official diagnosis, says Cecelia McWhorter, BA, CPC, an anesthesia and pain management coder with EmPhysis Medical Management Ltd. in Oklahoma City. For example, the patient may endure months or years of low back pain that radiates into his buttocks or tailbone but does not affect his leg. In time, the physician may take the next step to determine whether the patient has diskogenic pain. The first step toward diagnosing diskogenic pain is magnetic resonance imaging (MRI, CPT 72148-Cpt 72149 and Cpt 72156-CPT 72158). The MRI shows whether the patient's disks have signs of wear and tear or degenerative changes. (Tears or fissures in the disk walls can become a source of chronic pain. The inner disk tissue can also herniate into the fissures, which increases the patient's discomfort.) If the MRI shows disk changes, the physician might prescribe physical therapy to alleviate the pain. Other treatments may include pain management injections such as lumbar facet joint or facet joint nerve injections (64475-64476), lumbar/sacral transforaminal epidural injections (64483-64484), subarachnoid or epidural neurolytic injections/infusions (62280-62282), epidural or subarachnoid single injection (62311), or tendon or trigger point injections (20551-20552). Physicians often try these injections before opting for surgery or more serious actions to treat the patient's pain. Patients who still have pain after these more conservative therapies will undergo diskography to make a definitive disk-related diagnosis. The anesthesiologist or a neurosurgeon places a needle in the patient's disk and creates pressure to represent the actual tension the disk is under when the patient sits or stands. The physician injects dye during the test to fill cracks and allow him or her to see disk tears or fissures. A radiologist typically performs the diskography injection. But if the anesthesiologist performs it, McWhorter codes the procedure with either 62290* (Injection procedure for diskography, each level; lumbar) or 62291* ( cervical or thoracic), depending on the injection site. But she rarely uses 62291 because her physicians perform IDET almost exclusively in the lumbar region. You should code the radiological supervision and interpretation of diskography with 72295 (Diskography, lumbar, radiological supervision and interpretation) and append modifier -26 (Professional component) if the anesthesiologist [...]