Anesthesia Coding Alert

Automated percutaneous lumbar diskectomy (APLD) or laser-assisted disk compression is a new procedure for treating a herniated lumbar disk. Coders should be familiar with this pain-management procedure as more physicians offer the treatment to qualified patients.
 
During the procedure, the physician, usually an orthopedist or neurosurgeon, uses a specially designed probe to remove small pieces of the affected disk's nucleus. APLD is used on patients who have been treated with other pain-management techniques such as epidural steroid injections, trigger-point injections or opioid therapy, says Cindy Parman, CPC, CPC-H, principal and co-founder of the coding consulting firm Coding Solutions Inc., in Dallas, Ga. Diagnostic tests such as MRI or CT scans, EMG studies and diskographies have been performed on the patients to determine their need for APLD.
 
"Our anesthesiologists don't actually perform the procedure, but they do provide anesthesia for it," notes Carla Thibodeaux, CPC, an anesthesia coder with the physician group Texas Anesthesia in San Antonio. "However, it's important for us to know how to code it from a surgical perspective since many carriers require surgical CPT Codes instead of anesthesia codes."
Medical Necessity for APLD
The surgeon and anesthesiologist need to document the patient's medical necessity for APLD. Many insurance carriers consider APLD medically appropriate for "individuals who have physical and diagnostic-imaging evidence that a single lumbar disk has an uncomplicated herniation that is contained within the anulus," the Blue Cross/Blue Shield of Tennessee manual states. The patient must also exhibit signs such as acute unilateral leg pain localized to a single dermatome, neurologic signs or symptoms consistent with a nonsequestered-disk herniation, diagnostic-test results showing a single herniation within the anulus of a lumbar disk, and a conservative therapy plan that failed to relieve pain. Carriers such as Louisiana Medicare state that patients who have a history of lumbar surgery, evidence of severe spinal stenosis or indications of a progressive neurological deficit are ineligible.
 
Once medical necessity is confirmed, several diagnosis codes may be appropriate for documentation depending on the affected disk's location. Code 722.10 (lumbar intervertebral disk without myelopathy) is most common, Thibodeaux says. Other diagnoses include 722.51 (degeneration of thoracic or thoracolumbar intervertebral disk), 722.52 (degeneration of lumbar or lumbosacral intervertebral disk), 722.73 (intervertebral disk disorder with myelopathy; lumbar region) and 724.2 (other and unspecified disorders of back; lumbago).
 
Coders should check with their carriers to see which diagnosis codes are accepted for APLD. Louisiana Medicare, for example, only accepts 722.2 (displacement of intervertebral disk, site unspecified, without myelopathy) to support medical necessity for APLD. Choose the most specific ICD-9 codeto document the procedure's necessity.
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