Notification



Notification Issue Date:



Medical Policy Bulletin


Title:Percutaneous Discectomy

Policy #:11.15.15g

This policy is applicable to the Company’s commercial products only. Policies that are applicable to the Company’s Medicare Advantage products are accessible via a separate Medicare Advantage policy database.


The Company makes decisions on coverage based on Policy Bulletins, benefit plan documents, and the member’s medical history and condition. Benefits may vary based on contract, and individual member benefits must be verified. The Company determines medical necessity only if the benefit exists and no contract exclusions are applicable.

When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.

This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.



Policy

Coverage is subject to the terms, conditions, and limitations of the member's contract.

Although the US Food and Drug Administration (FDA) has approved devices for percutaneous discectomy, the Company has determined that the safety and/or effectiveness of this procedure cannot be established by review of the available published peer-reviewed literature. Therefore, percutaneous discectomy including percutaneous discectomy through an endoscope is considered experimental/investigational by the Company and not covered.
Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, percutaneous discectomy is not eligible for payment under the medical benefits of the Company’s products because the service is considered experimental/investigational and, therefore, not covered. Services that are experimental/investigational are a benefit contract exclusion for all products of the Company. Therefore, they are not eligible for reimbursement consideration.

US FOOD AND DRUG ADMINISTRATION (FDA) STATUS

There are numerous devices approved by the FDA for use in aspiration of disc nucleus pulposus during percutaneous discectomies in the lumbar, thoracic and cervical regions.

There are numerous endoscopes and associated surgical instruments approved by the FDA.

Description

The spinal column is composed of a series of connecting bones (i.e., vertebrae) that protect the nerves that exit the brain and travel down into the body. The vertebrae are divided into several segments (cervical, thoracic, lumbar, and sacral), with individual vertebrae separated by intervertebral discs. These intervertebral discs act as shock absorbers for the spinal column. The outer portion of the disc is known as the annulus fibrosus and is composed of collagen; the inner portion of the disc is known as the nucleus pulposus and is composed of a soft gelatinous material. When this soft gelatinous material herniates through the outer portion of the disc into the spinal canal, it may cause pain in the back or sciatica (i.e., numbness, pain, weakness, or tingling in the leg).

Herniation of the disc can be caused by strain, trauma, or disc degeneration and usually occurs in the lumbar region. This condition may be conservatively treated with bedrest, medication (e.g., analgesics for pain control, anti-inflammatories to reduce swelling, muscle relaxants), and/or physical therapy. Studies indicate that without surgery, individuals with herniated discs may improve 80 percent to 90 percent of the time. For individuals who do not respond to conservative treatment, surgical treatments may be explored, such as standard discectomy or microdiscectomy. Additionally, percutaneous discectomy has been explored as a potential surgical treatment option and is theorized to result in decreased morbidity and less potential for perineural scarring and intra-operative blood loss or infections.

Percutaneous discectomy (i.e., percutaneous disc decompression, percutaneous nucleotomy) is a surgical procedure used to treat herniated lumbar, thoracic, and cervical discs. It can be performed manually, using an automated device, or by laser. Performed through a needle inserted into the skin, in which portions of the intervertebral disc are accessed and removed through a cannula (i.e., surgical tube), the procedure is intended to relieve pressure on the nerves surrounding the disc. When percutaneous discectomy is performed manually, cutting forceps are used to remove the nuclear material from within the disc annulus. During automated percutaneous discectomy, a probe is used to excise small pieces of the nucleus by aspiration. Laser discectomy involves the placement of a laser within the nucleus, which is then activated to ablate the disc material. The Stryker DeKompressor® Percutaneous Discectomy Probe (Stryker) and the Nucleotome® (Clarus Medical) are examples of percutaneous discectomy devices that received clearance from the US Food and Drug Administration (FDA) for use in aspiration of disc material during percutaneous discectomies in the lumbar, thoracic, and cervical regions of the spine. Percutaneous endoscopic discectomy is also being investigated, which involves the percutaneous placement of a working channel under image guidance, followed by visualization of the working space and instruments through an endoscope, and aspiration of disc material.

PEER-REVIEWED LITERATURE

In a Cochrane Review, Gibson and Waddell (2007) evaluated the effects of various surgical interventions for the treatment of lumbar disc prolapse (i.e., slipped disc, herniated disc). The authors noted that while disc prolapse accounts for only five percent of low back disorders, it is one of the most common reasons for surgery. Forty randomized controlled trials and two additional studies were identified. The authors noted that many of the early trials described chemonucleolysis (i.e., dissolving the bulging disc with the use of an injected enzyme) as the primary intervention, whereas the majority of the later studies compared different techniques of discectomy. Four trials were identified which compared discectomy with conservative management. Specific to percutaneous discectomy, the authors concluded that there was insufficient evidence to draw firm conclusions. The study is limited in its heterogeneous population and surgical interventions.

In a literature review, Nezer and Hermoni (2007) evaluated the current state of evidence for percutaneous discectomy in treating low back pain. In addition to randomized controlled trials and systematic reviews, the authors assessed guidelines from the National Institute for Health and Clinical Excellence (NICE). The authors concluded that the results from these studies and guidelines indicate that until better scientific evidence is available, automated percutaneous discectomy and laser discectomy should be regarded as research techniques.

In a literature review, Goupille et al. (2007) evaluated the current state of evidence for percutaneous laser disc decompression in treating lumbar disc herniation. The authors noted that the concept of laser disc decompression was based on the percutaneous introduction of an optical fiber into the intervertebral disc. The administered laser energy would allow for the vaporization of portions of the nucleus pulposus, which may reduce intradiscal pressure and relieve radicular pain. The authors note that there is no consensus on the type of laser to use, the wavelength, duration of application, or appropriate energy applied. Study methodology and conclusions are questionable, and no controlled studies were published at the time of the literature review. The authors concluded that while the concept of laser disc decompression is appealing, the treatment cannot be considered effective for disc herniation--associated radiculopathy, refractory to conservative treatment.

In a retrospective study, Liu et al. (2010) evaluated the long-term outcomes of individuals with lumbar disc herniation who were treated with percutaneous lumbar discectomy (PLD) or microendoscopic discectomy (MED). One hundred and twenty nine individuals were treated with PLD and 101 individuals underwent MED. Ultimately, 80.62 percent of the PLD group (n=104) and 81.19 percent of the MED group (n=82) were eligible for analysis and followed for a mean of 6.64 ± 0.67 years and 6.42 ± 0.51 years, respectively. Outcome measurements included Oswestry Disability Index (ODI, higher scores indicate increased disability) and a 36-Item Short-Form Health Survey (SF-36), a standardized questionnaire used to measure an individual's overall subjective health status (higher scores indicate better overall health). The authors reported that 75.96 percent of the PLD group and 84.15 percent of the MED group achieved excellent or good results, representing a statistically significant difference (p = 0.0402). The average ODI scores and minimal disability were 6.97 percent and 71.15 percent in the PLD group and 4.89 and 79.27 percent in the MED group, respectively. The authors concluded that both PLD and MED show an acceptable long-term efficacy for the treatment of lumbar disc herniation, but admitted that compared with MED individuals, long-term satisfaction is lower in the PLD individuals. Additionally, individuals in the MED group had a statistically significantly higher rate of excellent or good results when compared with the PLD group. The study is limited in its small sample size and retrospective study design. Outcome measurements were also measured by both telephone and self-administered questionnaires, which may hinder the internal validity of the study.

In 2010, Teli et al. reported on an RCT comparing endoscopic discectomy to microdiscectomy or open discectomy in 240 individuals with posterior lumbar disc herniation. Most herniations (60 percent) were extrusions. The average surgical time was longer in the endoscopic group (56 minutes) than in the micro or open discectomy groups (43 minutes and 36 minutes, respectively). Follow-up assessments were performed at 6, 12, and 24 months by an independent investigator; 212 (91 percent) individuals completed the 24- month evaluation. Intention-to-treat analysis showed no significant differences in the outcome variables (visual analog scale [VAS], Oswestry Disability Index [ODI], and SF-36 scores). The endoscopic procedure led to more dural tears (8. 7 percent vs 2.7 percent or 3 percent), root injuries (3 percent versus 0 percent or 0 percent), and recurrent herniations (11.4 percent versus 4.2 percent or 3 percent) than the microdiscectomy or open approaches, respectively, although differences were not statistically significant.

In a retrospective study, Tzaan (2011) evaluated the safety and effectiveness of anterior percutaneous endoscopic cervical discectomy (APECD) for the treatment of cervical intervertebral disc herniation. A total of 107 consecutive individuals with clinically symptomatic cervical disc herniation were initially enrolled. Of these individuals, 80 percent (n=86) were followed for at least 12 months, for a mean of 22.4 months [12 to 60]. Visual analog scale (VAS) and neck disability index (NDI) scores had a statistically significant improvement after APECD (p < 0.001). Excellent and good outcomes were achieved in 34 percent (n=29) and 57 percent (n=49) of the individuals, respectively. Two individuals experienced operation related complications (carotid artery injury and postoperative headaches). The authors concluded that APECD is a minimally invasive method to treat cervical hernias. However, they cautioned that it carries the risk of major complications and that careful individual selection and the use of meticulous surgical techniques was important. The study is limited in its small sample size, mid-term follow-up period, retrospective design, and lack of a comparative control group.

Garg et al. (2011) reported on a trial randomizing 112 individuals with a single-level disc herniation to microendoscopic lumbar discectomy or to open discectomy. The method of randomization and whether individuals and assessors were blinded were not reported. Surgical time was significantly longer in the endoscopic group (84 minutes versus 56 minutes) while blood loss (41 mL versus 306 mL) and hospital length of stay (3 days versus 12 days) were reduced. Oswestry Disability Index (ODI) scores were similar at baseline (endoscopic, 25.78 versus open discectomy, 21.02) and all follow-up visits through one year postoperatively (endoscopic; 1.75 versus open discectomy 2.14).

In a prospective randomized controlled trial, Chitagran et al. (2012) evaluated the effectiveness of percutaneous nucleoplasty compared with conservative treatment in individuals with radicular or axial low back pain, secondary to contained herniated discs. Sixty-four individuals were randomized in a 1:1 ratio. Individuals were evaluated at 1, 3, 6, and 12 months postoperatively. Outcome measurements included VAS scores and pre- and post-nucleoplasty MRI at three months to evaluate the decrease of bulging discs. Reported pain and medication use had a statistically significant decrease and functional status had a statistically significant increase at 1, 3, 6, and 12 months post-nucleoplasty (p ≤ 0.001). The bulging disc was statistically significantly decreased at three months following nucleoplasty. The authors concluded that percutaneous nucleoplasty was an effective procedure for individuals presenting with discogenic back and/or radicular pain, refractory to conservative treatment. The study is limited in its small sample size and short-term follow-up period. Additionally, while comparisons can be made to conservative treatment, the effectiveness of percutaneous discectomy cannot be generalized in comparisons with more established surgical treatment options such as standard discectomy.

In a retrospective comparative study, Adam et al. (2013) evaluated the effectiveness of percutaneous nucleoplasty compared with open discectomy in individuals with degenerative disc disease and lumbar disc protrusions. Two cohorts of 80 individuals each were followed for up to one year. Individuals in the percutaneous nucleoplasty group had radicular symptoms caused by herniation, with a herniated disc less than six mm, refractory to conservative treatment. Individuals in the open discectomy group had a herniated disc greater than six mm. Outcome measurements included a Rolland-Morris disability questionnaire (higher scores indicate increased disability) and mean VAS scores preoperatively and at 3, 6, and 12 months after the respective procedure. VAS scores decreased from a preoperative score of 7.9 to 2.2 in the percutaneous nucleoplasty group and a preoperative score of 8 to 1.8 in the open discectomy group at one-year follow-up. Rolland-Morris disability scores improved in 60 percent of the individuals who underwent percutaneous nucleoplasty and 78 percent of the individuals who underwent open discectomy. The authors concluded that percutaneous nucleoplasty was a safe and effective method to treat individuals with lumbar disc protrusion. The study is limited in its small sample size, short-term follow-up period, and retrospective study design. Additionally, results were only presented with frequency analysis. Despite the comparative design, any attempts at statistical significance testing were not presented. The authors also admitted there were issues affecting the study’s internal validity, including patient compensation and potential study bias.

Eight-year follow-up from a quasi-RCT assessing endoscopic lumbar discectomy and open discectomy was reported by Hussein et al. (2014). The trial included 185 individuals with a large uncontained lumbar disc herniation. Surgery times were similar for both groups. Postsurgical mean hospital length of surgery was 10.4 hours for the endoscopic group and 82.38 hours (p<0.05) for the open group. Mean time to return to work/normal activities after endoscopic surgery (8.5 days) was significantly shorter than after open surgery (31.4 days; p<0.05). The percentages of adverse events were similar between groups, and 8.1 percent of individuals in each group required reoperation during the follow-up. Improvements in leg pain, back pain, and ODI scores (1.05, 1.43, 21.5 percent, respectively) persisted at eight years in the endoscopic group, but deteriorated for back pain (7.53) and ODI scores (59.6 percent) in the open group.

A number of observational studies have also assessed the learning curve (Lee 2008, Wang 20011, Tenenbaum 2011) and the need for longer follow-up for endoscopic discectomy (Casal-Moro 2011, Wang 2012, Cho 2015) . The largest and longest follow-up to date has been reported by Choi et al. (2015), who examined 10,228 individuals at their institution who had percutaneous endoscopic lumbar discectomy (PELD) over a 12-year period. They found that 4.3 percent of cases required reoperation in the first six weeks due to incomplete removal of herniated discs (2.8 percent), recurrence (0.8 percent), persistent pain (0.4 percent), and approach related pain (0.2 percent).

In 2016, Gotecha et al. published a prospective study on the use of transforaminal PELD for the treatment of lumbar disc herniation. Efficacy and limitations of the procedure were studied on 120 individuals with lumbar disc herniation. Using McNab criteria, 89 percent achieved excellent (no pain or restrictions) or good (occasional back/leg pain) status at six months of follow-up. The authors noted that a limitation of the procedure is that, during surgery on individuals with L5 through S1 lumbar disc herniation, the iliac crest may interfere with the angle necessary to perform successful discectomy.

A 2016 systematic review and meta-analysis published by Li et al. compared full endoscopic discectomy (FED) with traditional discectomy surgery. A literature search was conducted in January 2015 and resulted in the inclusion of four RCTs and two non-RCTs. FED for herniation (both cervical and lumbar) was favorable compared with traditional discectomy in surgery duration, blood loss, length of stay, and return to work days. Clinical outcomes were comparable between FED and traditional discectomy.

A 2016 meta-analysis identified nine RCTs (total N=1092 individuals) through August 2014 that compared endoscopic to open discectomy for lumbar disc herniation. Endoscopic discectomy resulted in clinical outcomes similar to open discectomy, but had significantly greater individual satisfaction, lower intraoperative blood loss, and shorter hospital length of stay.

In 2017, Gibson et al. published an RCT comparing transforaminal endoscopic discectomy (TED) with microdiscectomy. Individuals with single-level lumbar prolapse and radiculopathy were randomized to TED under conscious sedation (n=70) or to microdiscectomy under general anesthesia (n=70). Both procedures resulted in comparable improvements in outcomes (ODI scores, VAS back pain, VAS leg pain, SF-36 scores) at three months, one year, and two years compared with baseline.

In 2017, Phan et al. published a systematic review and meta-analysis comparing full endoscopic discectomy (FED) and microendoscopic discectomy (MED) with open discectomy for the treatment of lumbar disc herniation. A database search through February 2016 identified 23 studies for inclusion. FED was favorable compared with open discectomy in surgery duration, hospital length of stay, and blood loss. MED was favorable compared with open discectomy in terms of length of stay and blood loss. Both endoscopic procedures were comparable to open discectomy, as measured on a VAS for leg pain and ODI score. In terms of the individual's satisfaction, FED was more favorable than open discectomy, and MED was comparable to open discectomy.

PRACTICE GUIDELINES AND POSITION STATEMENTS

In a 2005 guideline, NICE addressed automated percutaneous mechanical lumbar discectomy. They noted that while current evidence suggests that there may be no major safety concerns associated with the procedure, there was limited evidence of effectiveness based on uncontrolled case series. The population for these studies included a heterogeneous group of individuals. Additionally, small randomized controlled trials showed conflicting results, which represents an uncertainty regarding the effectiveness of the procedure.

In a 2007 guideline, the American Society of Interventional Pain Physicians (ASIPP) addressed percutaneous disc decompression. This evidence-based practice guideline included literature searches, systematic reviews, consensus evaluations, blinded peer review, and open forum presentations. Based on the current state of evidence and clinical input, the ASIPP determined that percutaneous disc decompression remains controversial. Among the various techniques utilized for the procedure, the evidence was moderate in the short-term and limited in the long-term for procedures that utilize the Nucleotome® and DeKompressor® devices, including automated percutaneous lumbar discectomy percutaneous laser discectomy.

In a 2009 guideline, NICE addressed percutaneous endoscopic laser lumbar discectomy. They noted that the current evidence on the safety and effectiveness of the procedure was inadequate in quantity and quality. Adverse events included thecal sac injury with cerebrospinal fluid leakage, transient dysesthesia (i.e., abnormal sensation), and sympathetic mediated pain (i.e., pain related to involuntary body functions).

SUMMARY

There is limited literature indicating that percutaneous discectomy may yield symptom relief in a select group of individuals compared to conservative management or conventional surgical approaches (e.g., standard discectomy). The current available peer-reviewed literature describes heterogeneous populations and treatment modalities. Guidelines from various medical societies indicate that the current state of evidence is insufficient and has not yet provided clinical evidence that percutaneous discectomy is as safe and effective as conservative management or traditional surgical treatments. Therefore, the current available peer-reviewed literature does not support the use of percutaneous discectomy in lumbar, thoracic, and cervical areas of the spine.

For individuals who have herniated intervertebral disc(s) who receive percutaneous endoscopic discectomy, the evidence includes a number of RCTs and systematic reviews of RCTs. Relevant outcomes are symptoms, functional outcomes, quality of life, and treatment related morbidity. Many of the RCTs were conducted at a single center in Europe. Some trials have reported outcomes at least as good as traditional approaches with an open incision, while one RCT from a different center in Europe reported a trend toward increased complications and reherniations using an endoscopic approach. There are few reports from the United States. The evidence is insufficient to determine the effects of this technology on health outcomes.
References

Adam D, Pevzner E, Gepstein R. Comparison of percutaneous nucleoplasty and open discectomy in patients with lumbar disc protrusions. Chirurgia (Bucur). 2013;108(1):94-8.


Amoretti N, Hauger O, Marcy PY, et al. Percutaneous discectomy on lumbar radiculopathy related to disk herniation: Why under CT guidance? An open study of 100 consecutive patients. Eur J Radiol. 2011;81(6):1259-64.

Boswell MV, Trescot AM, Datta S, et al. American Society of Interventional Pain Physicians. Interventional techniques: evidence-based practice guidelines in the management of chronic and spinal pain. Pain Physician. 2007;10(1):7-111.

Brouwer PA, Peul WC, Brand R, et al. Effectiveness of percutaneous laser disc decompression versus conventional open discectomy in the treatment of lumbar disc herniation; design of a prospective randomized controlled trial. BMC Musculoskelet Disord. 2009;10:49.

Casal-Moro R, Castro-Menendez M, Hernandez-Blanco M, et al. Long-term outcome after microendoscopic diskectomy for lumbar disk herniation: a prospective clinical study with a 5-year follow-up. Neurosurgery. 2011;68(6):1568-1575; discussion 1575.

Chaichankul C, Poopitaya S, Tassanawipas W. The effect of learning curve on the results of percutaneous transforaminal endoscopic lumbar discectomy. J Med Assoc Thai. 2012;94(S10):S206-12.

Chatterjee S, Foy PM, Findlay GF. Report of a controlled clinical trial comparing automated percutaneous lumbar discectomy and microdiscectomy in the treatment of contained lumbar disc herniation. Spine. 1995;20(6):734-8.

Chitagran R, Poopitaya S, Tassanwipas W. Result of percutaneous disc decompression using nucleoplasty in Thailand: a randomized controlled trial. J Med Assoc Thai. 2012;95(S10):S198-205.

Choi G, Lee SH, Bhanot A, Raiturker PP, Chae YS. Percutaneous endoscopic discectomy for extraforminal lumbar disc herniations: extraforminal targeted fragmentectomy technique using working channel endoscope. Spine. 2007;32(2):E93-E99.

Choi KC, Lee JH, Kim JS, et al. Unsuccessful percutaneous endoscopic lumbar discectomy: a single-center experience of 10 228 cases. Neurosurgery. 2015;76(4):372-381.

Chou R, Atlas SJ, Stanos SP, et al. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine. 2009; 34(10):1078-93.

Chou R, Loeser JD, Owens DK, et al. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine. 2009;34(10):1066-1077.

Cong L, Zhu Y, Tu G. A meta-analysis of endoscopic discectomy versus open discectomy for symptomatic lumbar disk herniation. Eur Spine J. 2016;25(1):134-143.

Eloqayli H, Al-Omari M. Percutaneous discectomy: Minimally invasive method for treatment of recurrent lumbar disc herniation. Clin Neurol Neurosurg. 2012;114(7):871-5.

Franke J, Greiner-Perth R, Boehm H, Mahlfeld K, Grasshoff H, et al. Comparison of a minimally invasive procedure versus standard microscopic discotomy: a prospective randomised controlled clinical trial. Eur Spine J. 2009;18(7):992-1000.

Foster MR. Herniated nucleus pulposus. [eMedicine Web site]. 03/16/05. (Updated 02/03/2017). Available at: http://emedicine.medscape.com/article/1263961-overview. Accessed May 07, 2019.

Freeman BJ, Mehdian R. Intradiscal electrothermal therapy, percutaneous discectomy, and nucleoplasty: what is the current evidence? Curr Pain Headache Rep. 2008;12(1):14-21.

Garg B, Nagraja UB, Jayaswal A. Microendoscopic versus open discectomy for lumbar disc herniation: a prospective randomised study. J Orthop Surg. 2011;19(1):30-34.

Gibson JN, Subramanian AS, Scott CE. A randomized controlled trial of transforaminal endoscopic discectomy vs microdiscectomy. Eur Spine J. 2017;26(3):847-856.

Gibson JN, Waddell G. Surgical interventions for lumbar disc prolapse. The Cochrane Database Syst Rev. 2007;18(2):CD001350.

Gibson JN, Waddell G. Surgical interventions for lumbar disc prolapse: updated Cochrane Review. Spine. 2007;32(16):1735-47.

Gibson JNA, Grant IC, Waddell G. Surgery for lumbar disc prolapse. The Cochrane Database of Syst Rev. 2003;2.

Gotecha S, Ranade D, Patil SV, et al. The role of transforaminal percutaneous endoscopic discectomy in lumbar disc herniations. J Craniovertebr Junction Spine. 2016;7(4):217-223.

Goupille P, Mulleman D, Mammou S, et al. Percutaneous laser disc decompression for the treatment of lumbar disc herniation: a review. Semin Arthritis Rheum. 2007;37(1):20-30.

Haines SJ, Jordan N, Boen JR, et al. Discectomy strategies for lumbar disc herniation: results of the LAPDOG trial. J Clin Neurosci. 2002;9(4):411-417.

He SH, Zhao X, Wu XH, Ding H, Fang J. Percutaneous endoscopic lumbar discectomy for the treatment of upper lumbar disc herniation. Zhongguo Gu Shang. 2012;25(11):920-2.

Hermantin FU, Peters T, Quartararo L, et al. A prospective, randomized study comparing the results of open discectomy with those of video-assisted arthroscopic discectomy. J Bone Joint Surg Am. 1999;81(7):958-65.

Hirsch JA, Singh V, Falco FJ, et al. Automated percutaneous lumbar discectomy for the contained herniated lumbar disc: a systematic assessment of evidence. Pain Physician. 2009;12(3):601-620.

Hussein M, Abdeldayem A, Mattar MM. Surgical technique and effectiveness of microendoscopic discectomy for large uncontained lumbar disc herniations: a prospective, randomized, controlled study with 8 years of follow-up. Eur Spine J. 2014;23(9):1992-1999.

Lee DY, Lee SH. Learning curve for percutaneous endoscopic lumbar discectomy. Neurol Med Chir. 2008;48(9):383-388; discussion 388-389.

Lewis RA, Williams NH, Sutton AJ, et al. Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. Spine J. 2015;15(6):1461-1477.

Li XC, Zhong CF, Deng GB, et al. Full-endoscopic procedures versus traditional discectomy surgery for discectomy: a systematic review and meta-analysis of current global clinical trials. Pain Physician. 2016;19(3):103-118.

Liu WG, Wu XT, Guo JH, et al. Long-term outcomes of patients with lumbar disc herniation treated with percutaneous discectomy: comparative study with microendoscopic discectomy. Cardiovasc Intervent Radiol. 2010;33(4):780-6.

Liu WG, Wu XT, Min J, Guo JH, Zhuang SY, et al. Long-term outcomes of percutaneous lumbar discectomy and microendoscopic discectomy for lumbar disc herniation. Zhonghua Yi Xue Za Zhi. 2009;89(11):750-3.

Manchikanti L, Abdi S, Alturi S, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician. 2013;16:S49-S283.

Manchikanti L, Singh V, Calodney AK et al. Percutaneous lumbar mechanical disc decompression utilizing Dekompressor(R): an update of current evidence. Pain Physician. 2013;16(2 Suppl):SE1-24.

Manchikanti L, Singh V, Falco FJ et al. An updated review of automated percutaneous mechanical lumbar discectomy for the contained herniated lumbar disc. Pain Physician. 2013;16(2 Suppl):SE151-84.

Mayer HM, Brock M. Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy. J Neurosurg. 1993;78(2):216-225.

Menchetti PP, Canero G, Bini W. Percutaneous laser discectomy: experience and long term follow-up. Acta Neurochir Suppl. 2011;108:117-21.

National Institute for Health and Clinical Excellence. Automated percutaneous mechanical lumbar discectomy. November 2005. Available at: http://www.nice.org.uk/guidance/IPG141/chapter/1-Guidance. Accessed May 07, 2019.

National Institute for Health and Clinical Excellence. Percutaneous endoscopic laser lumbar discectomy. May 2009. Available at: https://www.nice.org.uk/guidance/IPG300/chapter/1-Guidance. Accessed May 07, 2019.

National Institute for Health and Care Excellence (NICE). Percutaneous transforaminal endoscopic lumbar discectomy for sciatica. 2016. Available at: https://www.nice.org.uk/guidance/ipg556. Accessed May 07, 2019.

National Institute for Health and Care Excellence (NICE). Percutaneous interlaminar endoscopic lumbar discectomy for sciatica. 2016. Available at: https://www.nice.org.uk/guidance/ipg555. Accessed May 07, 2019.

Nezer D, Hermoni D. Percutaneous discectomy and Intradiscal radiofrequency thermocoagulation for low back pain: evaluation according to the best available evidence. Harefuah. 2007;146(10):747-50.

Phan K, Xu J, Schultz K, et al. Full-endoscopic versus micro-endoscopic and open discectomy: A systematic review and meta-analysis of outcomes and complications. Clin Neurol Neurosurg.2017;154:1-12.

Rasouli MR, Rahimi-Movaghar V, Shokraneh F, et al. Minimally invasive discectomy versus
microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database Syst Rev. 2014;9:CD010328.

Revel M, Payan C, Vallee C, et al. Automated percutaneous lumbar discectomy versus chemonucleolysis in the treatment of sciatica. Spine. 1993;18(1):1-7.

Ruetten S, Komp M, Merk H, et al. Full-endoscopic anterior decompression versus conventional anterior decompression and fusion in cervical disc herniations. Int Orthop. 2009;33(6):1677-1682.

Ruetten S, Komp M, Merk H, et al. Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study. Spine. 2008;33(9):940-948.

Ruetten S, Komp M, Merk H, et al. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine. 2008;33(9):931-939.

Ruetten S, Komp M, Merk H, et al. Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Spinal Disord Tech. 2009;22(2):122-129.

Singh V, Benyamin RM, Datta S, et al. Systematic review of percutaneous lumbar mechanical disc decompression utilizing Dekompressor. Pain Physician. 2009;12(3):589-599.

Singh V, Manchikanti L, Benyamin RM, et al. Percutaneous lumbar laser disc decompression: a systematic review of current evidence. Pain Physician.2009;12(3):573-88.

Smith N, Masters J, Jensen C et al. Systematic review of microendoscopic discectomy for lumbar disc herniation. Eur Spine J. 2013; 22(11):2458-65.

Tassi GP. Comparison of results of 500 microdiscectomies and 500 percutaneous laser disc decompression procedures for lumbar disc herniation. Photomed Laser Surg. 2006;24(6):694-7.

Teli M, Lovi A, Brayda-Bruno M, et al. Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy. Eur Spine J. 2010;19(3):443-450.

Tenenbaum S, Arzi H, Herman A, et al. Percutaneous posterolateral transforaminal endoscopic discectomy: clinical outcome, complications, and learning curve evaluation. Surg Technol Int. 2011;21:278-283.

Timmermann J, Hahn M, Krueger K. Short-term follow-up: micro-invasive therapy of the cervical herniated disk by percutaneous nucleotomy. J Back Musculoskelet Rehabil. 2011;24(2):89-93.

Tzaan WC. Anterior percutaneous endoscopic cervical discectomy for cervical intervertebral disc herniation: outcome, complications, and technique. J Spinal Disord Tech. 2011;24(7):421-31.

US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Endius Spine Endoscope. Premarket notification database. [FDA Web site]. 01/27/1999. Available at:http://www.accessdata.fda.gov/cdrh_docs/pdf/k982819.pdf. Accessed May 07, 2019.

US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Laurimed Percutaneous Discectomy System. 510(k) Summary. 08/28/2008. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf8/K082194.pdf. Accessed May 07, 2019.

US Food and Drug Administration (FDA). Center for Devices and Radiological Health. Stryker Dekompressor TM Percutaneous Discectomy Probe. Premarket notification database. [FDA Web site]. 11/07/2003. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf3/k032473.pdf. Accessed May 07, 2019.

Vorobeychik Y, Gordin V, Fuzaylov D, et al. Percutaneous mechanical disc decompression using Dekompressor device: an appraisal of the current literature. Pain Med. 2012;13(5):640-646.

Wang B, Lu G, Patel AA, et al. An evaluation of the learning curve for a complex surgical technique: the full endoscopic interlaminar approach for lumbar disc herniations. Spine J. 2011;11(2):122-130.

Wang H, Cheng J, Xiao H, Li C, Zhou Y. Adolescent lumbar disc herniation: experience from a large minimally invasive treatment centre for lumbar degenerative disease in Chongqing, China. Clin Neurol Neurosurg. 2013;115(8):1415-9.

Wang M, Zhou Y, Wang J, et al. A 10-year follow-up study on long-term clinical outcomes of lumbar microendoscopic discectomy. J Neurol Surg A Cent Eur Neurosurg. 2012;73(4):195-198.




Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

62380, 62287, 0274T, 0275T


THE FOLLOWING CODE IS USED TO REPRESENT NEEDLE-BASED TECHNIQUES IN AREAS OTHER THAN THE LUMBAR REGION

22899



Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD - 10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD -10 Diagnosis Code Number(s)

This service is considered experimental/investigational for all diagnoses.


HCPCS Level II Code Number(s)

N/A


Revenue Code Number(s)

N/A

Coding and Billing Requirements


Cross References


Policy History

Revisions from 11.15.15g:
06/05/2019The policy has been reviewed and reissued to communicate the Company’s continuing position on Percutaneous Discectomy.
08/01/2018This policy has been reissued in accordance with the Company's annual review process.
12/01/2017 This version of the policy will become effective 12/01/2017.

The following CPT code has been added to this policy:

62380
(Experimental/Investigational).

Effective 10/05/2017 this policy has been updated to the new policy template format.

Version Effective Date: 12/01/2017
Version Issued Date: 12/01/2017
Version Reissued Date: 06/05/2019

Connect with Us        


© 2017 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.