Appeal type: Experimental/Investigational
Decision: Upheld

Diagnosis: Low back pain. 
Treatment: Current procedural terminology (CPT) code 62380 [endoscopic decompression of spinal cord, nerve root, including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar], CPT code 22526 [percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level], CPT code 22527 [percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral, including fluoroscopic guidance; 1 or more additional levels], and CPT code 76000 [fluoroscopy (separate procedure), up to 1 hour physician or other qualified healthcare professional time]. 
The insurer denied coverage for current procedural terminology (CPT) code 62380 [endoscopic decompression of spinal cord, nerve root, including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar], CPT code 22526 [percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level], CPT code 22527 [percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral, including fluoroscopic guidance; 1 or more additional levels], and CPT code 76000 [fluoroscopy (separate procedure), up to 1 hour physician or other qualified healthcare professional time]. 
The denial is upheld. 

This patient has chronic low back pain (cLBP). The patient's pain medications include Mobic and Tizanidine. The patient underwent Bilateral endoscopic discectomy at L (lumbar) 2-L3 and L4-L5, intradiscal electrothermal therapy (IDET), annuloplasty and then transforaminal epidural steroid injections. 

Mekhail et al (1) conducted a systematic review and meta-analysis of various techniques to treat chronic low back pain. With respect to IDET they wrote: "Pauza et al (2) conducted a randomized trial treated 32 patients with IDET and 24 patients with a sham procedure. Patients in the IDET group experienced a statistically significant improvement in visual analog scale (VAS) pain and Oswestry Disability Index (ODI) scores than in the sham group at 6 months follow-up (P=0.045 and P=0.050, respectively), but there were no statistically significant differences between groups in their short form (SF)-36 scores. 

While some other studies have tried to do cost benefit analysis, the fact that a large number of patients do not benefit and some need to go onto further surgery, argues against the use of this procedure. It is important to note that published clinical trials ended in 2010. IDET is not a widely accepted technique in pain management. 

The procedure was not likely to be more beneficial than standard treatments. There are Food and Drug Administration approved devices to perform this procedure. 50% of patients did not gain any benefit from this procedure and several have had to undergo further surgery. 

In summary, the denial of current procedural terminology (CPT) code 62380 [endoscopic decompression of spinal cord, nerve root, including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar], CPT code 22526 [percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level], CPT code 22527 [percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral, including fluoroscopic guidance; 1 or more additional levels], and CPT code 76000 [fluoroscopy (separate procedure), up to 1 hour physician or other qualified healthcare professional time and coverage for the requested treatment should be upheld. This treatment is not likely to be more beneficial than any standard treatments for this patient's condition and the adverse risk are substantially increased over standard treatments.