april 2009

SELECTIVE ENDOSCOPIC DISKECTOMY with THERMAL ANNULOPLASTY (SED/TA)

There are other names associated with this procedure such as endoscopic lumbar microdiscectomy, or Yeung endoscopic procedure. The equipment can be identified as Yeung Endoscopic Spinal System (YESS) or the Ellman Trigger-Flex Probe. The best application of this procedure comes with foraminal or extra-foraminal disk herniations since the approach with an endoscope can be more direct when it comes to accessing the area of disc herniation. Once the site is visualized an endoscopic discectomy is performed to remove disk fragments and then the Trigger-Flex probe can be inserted under endoscopic visualization to treat the annular tear using radiofrequency energy ablating inflamed tissue and shrinking the collagen fibers which in turn decompresses the nerve root.

For the purposes of coding let me remind you of the AMA Guidelines that state;

“If there is no heading of endoscopy or there is not a specific code describing the use of an endoscope in its descriptor, then the codes described in that section are "open" surgical procedures and should not be used to report a procedure using an endoscopic approach.” “If it is determined there is not a specific code for the endoscopic procedure you are attempting to code, use the unlisted procedure endoscopy code to report the procedure, If there is not a specific unlisted endoscopy code, then use the general unlisted procedure code from the appropriate anatomic subsection of CPT.” Since there isn’t an endoscopic CPT code to describe an SED/TA procedure – Report 22899 Unlisted procedure, spine.

Reporting CPT codes 63056, 62287, and/or 22526 would not be appropriate because they represent open and percutaneous approaches and not the endoscopic approach. CPT codes 63020-63035 do have an “endoscopically-assisted approach” but these codes do not address the annuloplasty portion of the procedure. Another reason for not using these codes is that there are a number of Carriers that consider radiofrequency of the nucleus pulposus using the YESS system investigational/experimental resulting in coverage restrictions for this type of procedure. You should contact your individual carriers for coverage and reporting guidelines.