Decompression of the Intervertebral Disc Using Laser Energy (Laser Discectomy) or Radiofrequency Coblation (Nucleoplasty)

Policy ID: S-5093-03

Section: Surgery

Effective Date: July 01, 2018

Revised Date: January 06, 2023

Revision Effective Date: March 06, 2023

Last Reviewed: January 26, 2023

Applies To: Commercial and Medicaid Expansion

Description

Discogenic Low Back Pain

Discogenic low back pain is a common, multifactorial pain syndrome that involves low back pain without radicular symptoms findings, in conjunction with radiologically confirmed degenerative disc disease.

Treatment

Typical treatment includes conservative therapy with physical therapy and medication management, with potential for surgical decompression in more severe cases.

Summary of Evidence

For individuals who have discogenic back pain or radiculopathy who receive laser discectomy, the evidence includes systematic reviews of observational studies. Relevant outcomes are symptoms, functional outcomes, and treatment-related morbidity. While numerous case series and uncontrolled studies have reported improvements in pain levels and functioning following laser discectomy, the lack of well-designed and -conducted controlled trials limits interpretation of reported data. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

For individuals who have discogenic back pain or radiculopathy who receive disc nucleoplasty with radiofrequency coblation, the evidence includes randomized controlled trials (RCTs) and systematic reviews. Relevant outcomes are symptoms, functional outcomes, and treatment-related morbidity. For nucleoplasty, there are three (3) RCTs in addition to several uncontrolled studies. These RCTs are limited by the lack of blinding, an inadequate control condition in one (1), inadequate data reporting in the second, and low enrollment with early study termination in the third. The available evidence is insufficient to permit conclusions concerning the effect of these procedures on health outcomes due to multiple confounding factors that may bias results. High-quality randomized trials with adequate follow-up (at least one (1) year), which control for selection bias, the placebo effect, and variability in the natural history of low back pain, are needed. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

Criteria

Laser discectomy and radiofrequency coblation (disc nucleoplasty) are considered investigational as techniques of disc decompression and treatment of associated pain

Procedure Codes

62287

77002

S2348

Diagnosis Codes

Not Applicable

Professional Statements and Societal Positions Guidelines

Practice Guidelines and Position Statements

National Institute for Health and Care Excellence

In 2016, the National Institute for Health and Care Excellence NICE) updated its guidance on laser lumbar discectomy for the treatment of sciatica. The guidance stated that current evidence “is inadequate in quantity and quality.”

NICE also updated its guidance on percutaneous disc decompression using coblation for lower back pain and sciatica in 2016. NICE stated: “Current evidence on percutaneous coblation of the intervertebral disc for low back pain and sciatica raises no major safety concerns. The evidence on efficacy is adequate and includes large numbers of individuals with appropriate follow-up periods.” The guidance also noted that the individual should be informed of the range of treatment options available.

American Pain Society

American Pain Society practice guidelines (2009) on nonsurgical interventions for low back pain found that “there is insufficient (poor) evidence from randomized trials (conflicting trials, sparse and lower quality data, or no randomized trials) to reliably evaluate” a number of interventions including coblation.

American Society of Interventional Pain Physicians

Practice guidelines on lumber disc compression and chronic spinal pain were published in 2009 and updated in 2013, respectively, by the American Society of Interventional Pain Physicians. The systematic reviews informing the 2013 guidelines found limited evidence for percutaneous laser disc decompression and limited to fair evidence for nucleoplasty.

ND Committee Review

Internal Medical Policy Committee 11-14-2019 currently investigational for all

Internal Medical Policy Committee 01-19-2021 Coding update-

Added procedure code 77002.

Internal Medical Policy Committee 01-26-2023 - Effective March 06, 2023

Added Summary of Evidence
Updated References

Links

References (PDF)

Disclaimer

Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically.

Policy ID: S-5093-02