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-   -   Intradiscal Lumbar PRP Injection (http://www.aapc.com/memberarea/forums/showthread.php?t=85318)

katmarbar 01-04-2013 05:03 PM

Intradiscal Lumbar PRP Injection
I have received lots of opinions on how best to code this procedure the first time with out hitting a payer edit:

L2-3, L5-S1 Intradiscal Platelet Rich Plasma Injection - I am not worried about the PRP (0232T) transitional code.

I have been advised to use 22899 - unlisted spinal procedure, 64999 unlisted nervous system procedure and also 62292 which is a injection procedure for chemonucleolysis...

I have been coding 22899, which makes most sense to me as a coder as this is an unlisted spinal procedure and it does not have anything to do with nerves.

Thank you for your input! :)

dwaldman 01-05-2013 08:13 AM

Stedman's medical dictionary
1.Rarely used technique involving injection of chymopapain into the nucleus pulposus of an intervertebral disc as a therapeutic option for the treatment of a herniated nucleus pulposis (slipped disk).

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Chymopapain (brand name Chymodiactin) is a proteolytic enzyme isolated from the latex of papaya (Carica papaya). It is a medication used to treat herniated lower lumbar discs in the spine.[1] Chymopapain injections are normally given under local, rather than general, anaesthesia. The dose for a single intervertebral disc is 2 to 4 nanokatals, with a maximum dose per patient of 8 nanokatals.


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Optum Encoder
Injection procedure for chemonucleolysis, including discography, intervertebral disc, single or multiple levels, lumbar

Lay Description
This procedure introduces a corrective chemical enzyme into a herniated disc. The patient is placed in a spinal tap position on the left side. In a separately reported procedure, an x-ray verifies location of the disc. Once the disc is located, local anesthesia is injected and a small stab wound is made. A spinal needle is inserted with additional monitoring of placement and injection of anesthesia. Without puncturing the dura, the physician inserts the needle into the disc. This procedure can be performed with one or two needles. A separately reportable saline acceptance test is performed to verify correct placement. Discography is performed with an opaque substance to verify location of the herniated disc. A reparative enzyme is injected. The needles are removed and the wound is dressed.

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I would use the unlisted code you are reporting CPT 22899. If it is felt the procedure would be performed often. Then pay for a response from the AMA CPT Network, to get official response. And then it is not soley a matter of opionions of those involved.

marvelh 01-05-2013 09:08 PM

CPT code 0232T includes the injection - see descriptor...

Injection(s), platelet rich plasma [u]any site[u], including image guidance, harvesting and preparation when performed

There wouldn't be a separate code for the intradiscal injection. Hope this was pre-authorized or patient responsibility. I don't know of many payers covering intra-discal PRP

katmarbar 01-07-2013 03:21 PM

Thank you for your input. I am aware the transitional code is bundled with the injection. We are Pain management and do not fall under the Ortho clause where the procedure cannot be billed and you are correct that no payer are reimbursing for the transitional code. We are having patient sign an ABN for the PRP kit that do have an active insurance policy.

Have a great week!

Katie :)

dwaldman 01-08-2013 09:40 PM

I didn't mention 0232T because of the following statement from CPT Assistant.

"The intent of code 0232T is that it should not be reported for use of platelet rich plasma in procedures performed on the spine. "

October 2012 page 14

Frequently Asked Questions:Anesthesia: Other Procedures

Question: A patient with a diagnosis of cervical disc disease, broad based posterior disc bulge at C3-C4, and radiculopathy of left upper extremity undergoes the following procedure performed by one primary surgeon and one assistant surgeon: A spinal needle was inserted into the disc space at C3-C4. This was confirmed on fluoroscopic views. The discogram was performed using indigo carmine dye mixed with radiotracer dye in order to stain the disc material blue so as to differentiate it from the surrounding neural elements. A guidewire was placed through the spinal needle and the spinal needle was extracted. This was once again confirmed with fluoroscopy. Sequential dilators were placed over the guidewire. An endoscope was inserted after the final dilator was placed with the working tube. The disc space was inspected. Microdiscectomy was performed. This was carried back to the annulus. The incision was irrigated well. Platelet-rich plasma gel which was harvested at the start of the case via peripheral blood drawn and prepped on the back table via centrifuge was placed into the surgical wound. The wound was closed and sterile dressings were applied. The patient was then placed into a cervical collar. May codes 62287 and 0232T be reported with modifier 62, Two Surgeons, appended?

Answer: No. There is no specific code for the described procedures when performed in the cervical region. Therefore, code 64499, Unlisted procedure, nervous system, should be reported once by each physician. It would not be appropriate for either surgeon to report code 62287, Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization, with the use of an endoscope, with discography and/or epidural injection(s) at the treated level(s), when performed, single or multiple levels, lumbar, as this describes work performed only in the lumbar (not cervical) spinal region. Also, Category III code 0232T, Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed, is not reportable for this procedure performed in the spinal region. The intent of code 0232T is that it should not be reported for use of platelet rich plasma in procedures performed on the spine.

Neither modifier 80, Assistant Surgeon, nor modifier 62 should be appended to code 64499. Because unlisted codes do not include descriptor language that specifies the components of a particular service, these codes are reported without modifiers. Modifiers are used to indicate that a service or procedure performed was altered by some specific circumstance, but not changed in its definition or code. Because unlisted codes do not include descriptor language that specifies the components of a particular service, there is no need to "alter" the meaning of the code. Since the unlisted procedure code is being reported, documentation should be submitted describing the procedure performed.

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