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Percutaneous decompression of the nucleus pulposus of a herniated lumbar intervertebral disc is a minimally invasive procedure designed to alleviate pain and discomfort caused by a contained herniated disc. This procedure employs a needle-based technique to remove disc material, utilizing fluoroscopic imaging or other forms of indirect visualization to guide the process. The primary goal is to relieve pressure on the spinal nerves by removing bulging disc material that has not ruptured. Various methods can be employed during this procedure, including manual techniques, automated systems, and advanced technologies such as radiofrequency or laser applications. Each method involves the careful insertion of specialized instruments through a needle that is strategically placed between the vertebrae, allowing access to the center of the disc. Radiographic monitoring, particularly fluoroscopy, is crucial for ensuring accurate placement and guiding the removal of herniated tissue. Techniques such as laser ablation or coblation nucleoplasty are utilized to effectively vaporize or disintegrate the disc material, creating channels that further decompress the disc. This procedure can be performed at single or multiple lumbar levels, making it a versatile option for patients suffering from lumbar disc herniation.
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The percutaneous decompression procedure is indicated for patients experiencing symptoms related to a contained herniated lumbar intervertebral disc. The following conditions may warrant this procedure:
The percutaneous decompression procedure involves several key steps to ensure effective treatment of the herniated disc:
After the percutaneous decompression procedure, patients are typically monitored for a short period to ensure there are no immediate complications. Post-procedure care may include recommendations for rest, pain management, and gradual return to normal activities. Patients are often advised to avoid heavy lifting or strenuous activities for a specified period to allow for proper healing. Follow-up appointments may be scheduled to assess recovery and the effectiveness of the procedure in alleviating symptoms.
| Short Descr | DCMPRN PX PERQ 1/MLT LUMBAR | Medium Descr | DCMPRN PX PERQ NUCLEUS PULPOSUS 1/MLT LVL LUMBAR | Long Descr | 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 discography and/or epidural injection(s) at the treated level(s), when performed, single or multiple levels, lumbar | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 3 - Laminectomy, excision intervertebral disc |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AG | Primary physician | GC | This service has been performed in part by a resident under the direction of a teaching physician | KX | Requirements specified in the medical policy have been met | LT | Left side (used to identify procedures performed on the left side of the body) | X2 | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services |
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| 2022-01-01 | Note | Short and Medium description changed. |
| 2017-01-01 | Changed | Long description changed. |
| 2017-01-01 | Changed | Guidelines changed. |
| 2012-01-01 | Changed | Description Changed |
| 2011-11-30 | Changed | Changed AMA Guidelines per Corrections Notice 2012. Effective 2012-01-01 |
| 2009-01-01 | Changed | Code description changed |
| 2007-01-01 | Changed | Code description changed. |
| 1991-01-01 | Added | First appearance in code book in 1991. |
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