CurrentAetnaPolicy 0733

Discography

Defines medical necessity and investigational/experimental status for discography procedures, specifying lumbar provocative discography as medically necessary in limited circumstances and labeling cervical/thoracic and other discography techniques as experimental/investigational.

Policy Summary

PayerAetna

PolicyDiscography

Policy CodePolicy 0733

Change TypeNo material change

Effective Date

Next Review Date

Key ActionProvider must document persistent, severe LBP, abnormal interspaces on MRI, failure of other diagnostic tests to identify source, and that surgical intervention is being considered.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes reported in this brief (has_material_change=false).

1Medically necessary indication (lumbar provocative discography)

3Procedures considered experimental/investigational

~40%Estimated proportion of LBP due to disc

Level IIIEvidence strength (lumbar)

Level IVEvidence strength (cervical)

Coverage Summary

Scope: The policy defines that lumbar provocative discography is considered medically necessary in limited circumstances — specifically for evaluation of disc pathology in persons with persistent, severe low back pain (LBP) and abnormal interspaces on MRI when other diagnostic tests have failed to identify a suspected disc source and surgical intervention is being considered. Cervical and thoracic provocative discography and other techniques (including functional anesthetic discography and contrast disc analysis/mapping) are designated experimental and investigational (not covered) due to insufficient evidence of effectiveness.

Background: Discography is an invasive diagnostic test that injects contrast into the intervertebral disc to reproduce pain and evaluate internal disc disruption (often followed by CT). Evidence is mixed and controversial: some studies and guidelines support selective use for lumbar discogenic pain, while systematic reviews and long-term studies raise uncertainty about its diagnostic utility and possible harms — including infection (discitis) and data suggesting accelerated disc degeneration and increased subsequent imaging/surgery after disc puncture. Clinical guidance advises against using discography as a stand-alone test and warns it should not be performed when lumbar MRI is normal.

High-level statistics and evidence strength

Estimated proportion of LBP due to intervertebral disc~40%

MRI sensitivity for internal disc disruption (Zhou & Abdi 2006)26.7% to 59% (low sensitivity)

Evidence strength across techniquesVariable (some techniques 2B+; overall mixed)

Systematic review evidence level (lumbar)Lumbar: Level III (may be useful per IASP criteria)

Systematic review evidence level (cervical)Cervical: Level IV / weaker evidence

Definitions & Key Evidence Metrics

Definitions:

Provocative discography — Injection of radiopaque contrast into the intervertebral disc to reproduce the patient's pain and evaluate internal disc disruption, often followed by CT.

Functional anesthetic discography (FAD) — Injection of local anesthetic into suspected disc(s) during provocative movement to assess pain relief as an indicator that the disc is symptomatic.

Concordant pain — Discography-provoked pain of similar character and location to the patient's usual pain (examples in studies used thresholds such as ≥8/10 pain intensity).

Discoblock — Injection of local anesthetic into a degenerated disc proposed as an alternative diagnostic test to provocative discography.

Key evidence metrics and outcomes

Fang et al. meta-analysis (HIZ correlations)OR 47.79 for HIZ vs abnormal morphology; OR 8.65 for HIZ vs pain reproduction

Discitis incidence without antibiotics (Willems review)0.25% per patient (12/4,891) or 0.094% per disc (12/12,770)

Carragee et al. 10-year follow-up (disc degeneration)Injected discs: 35% progressed vs controls 14%; new herniations 55 vs 22

Xi et al. (selection for fusion) - concordant pain thresholdConcordant pain defined as intensity ≥8/10; positive with CT annular tears ≤2 levels and ≥1 negative control disc

Manchikanti systematic review conclusionLumbar provocation discography may be useful (Level III); cervical weaker; thoracic none

CMS / evidence on outcomesEffect on clinical outcomes is uncertain; value controversial

Pinto et al. (2022) - degeneration and fusionDiscogram patients had higher degeneration and more interval fusion; among discogram patients without fusion, degeneration comparable to controls at ≥5 years

Coding

CPT codes covered if selection criteria are metCPTCovered

62290	Injection procedure for discography, each level; lumbar [not covered for functional anesthetic discography]
72295	Discography, lumbar, radiological supervision and interpretation [not covered for functional anesthetic discography]

CPT codes not covered for indications listed in the CPBCPTNot Covered

62291	Injection procedure for discography, each level; cervical or thoracic
72285	Discography, cervical or thoracic, radiological supervision and interpretation

Other related HCPCSHCPCS

Q9951	High and low osmolar contrast material
Q9958	High and low osmolar contrast material
Q9959	High and low osmolar contrast material
Q9960	High and low osmolar contrast material
Q9961	High and low osmolar contrast material
Q9962	High and low osmolar contrast material
Q9963	High and low osmolar contrast material
Q9964	High and low osmolar contrast material
Q9965	High and low osmolar contrast material
Q9966	High and low osmolar contrast material

1–10 of 11

1/2

ICD-10 codes covered if selection criteria are met (lumbar/lumbosacral region and related diagnoses)ICD-10Covered

M43.06	Acquired spondylolisthesis
M43.07	Acquired spondylolisthesis
M43.16	Acquired spondylolisthesis
M43.17	Acquired spondylolisthesis
M46.46	Other and unspecified disc disorder, lumbar/lumbosacral region
M46.47	Other and unspecified disc disorder, lumbar/lumbosacral region
M51.86	Other and unspecified disc disorder, lumbar/lumbosacral region
M51.87	Other and unspecified disc disorder, lumbar/lumbosacral region
M47.16	Other spondylosis with myelopathy, lumbar/lumbosacral region
M47.17	Other spondylosis with myelopathy, lumbar/lumbosacral region

1–10 of 60

1/6

No specific billing/coding listed in this partmixed

No codes listed

Provider Actions

Documentation Required

Document medical necessity for lumbar provocative discography

Document persistent, severe low back pain, MRI demonstrating abnormal interspaces, that other diagnostic tests have failed to identify the suspected disc as the pain source, and that surgical intervention is being considered. Also note that discography should not be used as a standalone test and should not be attempted in individuals with a normal lumbar MRI.

Denial Risk

Denial risk for procedures outside specified indications

Procedures performed outside the policy’s specified indications are considered experimental/investigational and are at risk for denial.

62291
72285

Documentation Required

Use of provocative discography for surgical selection

When using provocative discography to help select lumbar fusion candidates, document the presence of concordant pain (e.g., intensity ≥8/10 reported in some studies), CT evidence of annular tear at no more than two contiguous levels, and at least one negative control disc to support the surgical decision.

Document concordant pain (eg ≥8/10)
CT annular tear ≤2 contiguous levels
At least one negative control disc

Documentation Required

Consider alternatives and informed consent for risks

Counsel patients that the diagnostic utility of provocative discography is uncertain and that harms have been reported, including accelerated disc degeneration, increased subsequent imaging and surgeries, and risk of discitis/infection. Consider less invasive alternatives such as discoblock or correlation with MRI high-intensity zone (HIZ) findings, and obtain informed consent discussing these risks and alternatives.

Policy Summary

PayerAetna

PolicyDiscography

Policy CodePolicy 0733

Change TypeNo material change

Effective Date

Next Review Date

Key ActionProvider must document persistent, severe LBP, abnormal interspaces on MRI, failure of other diagnostic tests to identify source, and that surgical intervention is being considered.

SourceLink

On This Page

OpenPayer

Discography

Coverage Summary

Medical-Necessity Criteria

Not Covered / Experimental

Evidence Summary & Conclusions

Definitions & Key Evidence Metrics

Coding

Provider Actions

Medicare Determinations

Revision History

Date	Determination