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Back pain related to herniated discs is an extremely common condition and a frequent cause of chronic disability. Although many cases of acute low back pain will resolve with conservative care, a surgical decompression is often considered when the pain is unimproved after several months and is clearly neuropathic in origin, resulting from irritation of the nerve roots. Open surgical treatment typically consists of some sort of discectomy, in which the extruding disc material is excised. Minimally invasive options have also been researched, in which some portion of the disc material is removed or ablated, although these techniques are not precisely targeted at the offending extruding disc material. Ablative techniques include laser discectomy and radiofrequency decompression. This is discussed in the Decompression of Intervertebral Discs Using Laser (Laser Discectomy) or Radiofrequency Energy (DISC Nucleoplasty^TM ) medical policy. In addition, intradiscal electrothermal annuloplasty is another minimally invasive approach to low back pain. In this technique, radiofrequency energy is used to treat the surrounding disc annulus (see the Percutaneous Intradiscal Electrothermal (IDET) Annuloplasty and Percutaneous Intradiscal Radiofrequency Annuloplasty medical policy).

This policy addresses percutaneous lumbar discectomy (PLD), in which the disc dcompression is accomplished by the physical removal of disc material rather than its ablation. Originally, PLD was performed manually, using cutting forceps to remove nuclear material from within the disc annulus. This technique has been replaced with automated devices that involve placement of a probe within the intervertebral disc and aspiration of disc material using a suction cutting device. The Stryker DeKompressor Percutaneous Discectomy Probe (Stryker) and the Nucleotome (Clarus Medical) are examples of percutaneous discectomy devices that received clearance from the U.S. Food and Drug Administration (FDA) through the 510(k) process. Both have the same labeled intended use, i.e., “for use in aspiration of disc material during percutaneous discectomies in the lumbar, thoracic and cervical regions of the spine.”

Endoscopic discectomy is considered investigational as a technique of intervertebral disc decompression in patients with back pain related to disc herniation in the lumbar, thoracic, or cervical spine.

Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

7/3/2001: ICD-9 code range 722.0-722.9 deleted

2/11/2002: Investigational definition added

5/2/2002: Type of Service and Place of Service deleted

6/11/2002: HCPCS code S2370 added

11/2002: Hyperlink added

9/29/2003: HCPCS S2370 deleted

3/25/2004: Reviewed by MPAC, remains investigational, FEP exception added

5/19/2004: Code Reference section updated, CPT code 62287 description revised, ICD-9 diagnosis code 722.52, 722.73 description revised

1/22/2007: Policy reviewed, discussion rewritten for clarity, no changes in policy statement

12/19/2008: Policy reviewed, no changes

12/31/2008: CPT code 62267 added as  non-covered; CPT code 62287 description revised

04/23/2010: Policy title changed from “Percutaneous Lumbar Discectomy” to “Automated Percutaneous Discectomy.” Policy description updated regarding devices; added links to related policies. Policy statement unchanged. FEP verbiage added to the Policy Exceptions section. Deleted outdated references in the Sources section.

04/20/2011: Policy reviewed; no changes.

02/24/2012: Policy reviewed; no changes.

04/11/2012: Add the following policy statement: Endoscopic discectomy is considered investigational as a technique of intervertebral disc decompression in patients with back pain related to disc herniation in the lumbar, thoracic, or cervical spine. Added "Endoscopic" to the policy title.

All codes billed for this procedure are considered investigational and not eligible for coverage.

Non-Covered Codes

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