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Chemonucleolysis is a minimally invasive procedure aimed at treating herniated nucleus pulposus, commonly known as a herniated disc. This condition occurs when the gelatinous center of the intervertebral disc, called the nucleus pulposus, bulges or ruptures, leading to pain and discomfort. The procedure involves the injection of an enzyme called chymopapain directly into the affected disc. Chymopapain works by dissolving the gelatinous material, thereby reducing pressure on surrounding nerves and alleviating pain. The patient is typically positioned on their side to facilitate access to the lumbar region of the spine. Prior to the injection, the skin over the injection site is thoroughly cleansed with an antiseptic solution to minimize the risk of infection. A local anesthetic is administered to ensure the patient remains comfortable during the procedure. The use of fluoroscopic guidance is essential for accurately positioning the needle within the disc. This technique allows the physician to visualize the needle's placement in real-time, ensuring precision and safety. The procedure may involve the injection of saline or contrast material to confirm the correct disc is targeted, and the patient's response is monitored closely to assess for any hypersensitivity to the enzyme. If the initial test dose is well-tolerated, a full therapeutic dose of chymopapain is then administered, which may be repeated for multiple affected discs if necessary.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure of chemonucleolysis is indicated for patients experiencing symptoms related to herniated nucleus pulposus, which may include:
The chemonucleolysis procedure involves several critical steps to ensure safety and effectiveness:
After the chemonucleolysis procedure, patients are typically advised to rest and avoid strenuous activities for a short period. Monitoring for any immediate adverse reactions is crucial, and patients may be instructed to report any unusual symptoms, such as increased pain or neurological changes. Follow-up appointments may be scheduled to assess the effectiveness of the treatment and to determine if additional interventions are necessary. Recovery times can vary, and patients are encouraged to engage in physical therapy or rehabilitation as recommended to support healing and improve functional outcomes.
| Short Descr | NJX CHEMONUCLEOLYSIS LMBR | Medium Descr | INJECTION PX CHEMONUCLEOLYSIS 1/MLT LUMBAR | Long Descr | Injection procedure for chemonucleolysis, including discography, intervertebral disc, 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) | 0 - 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 | Office-based surgical procedure added to ASC list in CY 2008 or later without MPFS nonfacility PE RVUs; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 9 - Other OR therapeutic nervous system procedures |
| LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | 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. |
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| 2007-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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