Anesthesia Coding Alert

Increasingly, commercial payers and some local Medicare carriers cover IntraDiscal ElectroThermal (IDET) therapy. Because guidelines are carrier-specific, individual payers should be asked before a procedure is performed if  it is covered and, if so, which codes are used.
 
The coding of IDET treatment of disc-related lower back pain has been controversial since the technique received FDA clearance in 1998. Although the number of commercial carriers that pay for IDET is increasing, many still do not cover the treatment. Some local Medicare carriers also do not cover the technique, which they consider investigational.
 
IDET has other reimbursement issues. No CPT code describes the procedure, which further complicates coding and billing.
 
IDET is a form of intradiscal heating that involves positioning a catheter with a resistive coil at its tip that generates heat. (Another method uses a needle to deliver radiofrequency-generated heat.) In both methods, the controlled heat causes cauterization of granulation tissue, the shrinking of collagen fibers and thermocoagulation of nervous tissue. It is used in the treatment of discogenic pain that is not successfully treated with the more traditional approaches of medications, injections and physical therapy. 
 
Many pain physicians and a growing number of carriers consider the noninvasive service to be a cheaper and safer alternative to spinal fusion for some patients, particularly those with chronic lower back pain and with annular disruption in one or more discs.
Reimbursement Issues  
Although good treatment outcomes have been reported, many carriers do not cover IDET treatments. Some Medicare carriers (i.e., Florida Medicare) clearly state in their LMRPs that IDET procedures are not covered because they are considered investigational.
 
This is true for some commercial carriers, such as Aetna U.S. Healthcare, which lists IDET among its non-covered services. Aetna's published policy on IDET states: "In the early stages of investigation, [IDET] appears promising; however, further study is warranted to compare efficacy against other intradiscal heating procedures, to determine the precise pathology most successfully treated by the procedure, and to assess the long-term outcomes of this procedure as compared to other more conventional therapies."
 
Meanwhile, even among payers who reimburse IDET treatment, the means by which they do so may vary greatly, in part because there is no CPT code for the treatment and in part because such cases are reviewed on a case-by-case basis.
 
Some of the Medicare carriers willing to pay for IDET for some patients want unlisted-procedure code 64999 (unlisted procedure, nervous system) used. This code is also recommended by the AMA and by most coding specialists, including Amy Mowles, a nationally recognized speaker on pain management and CEO of Mowles Medical Practice Management in Bowie, Md.
 
"Procedure notes need to be attached to the claim because it is an unlisted code," Mowles says. Because [...]