Discography (PDF)
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Defines medical necessity determinations for lumbar, cervical, and thoracic discography for health plans affiliated with Centene Corporation, including policy statements that lumbar discography is not medically necessary and that evidence is insufficient for cervical/thoracic discography. References CPT codes and background evidence.
Added clarifying language to Criteria I.
Replaced 'experimental/investigational' verbiage in policy statement II with 'there is insufficient evidence in the published peer-reviewed literature to support the use of cervical and thoracic discography.'
Policy split from CP.MP.63 Pain Management Procedures.
Coverage Summary
Policy Number: CP.MP.115; Status: CURRENT. Lumbar discography is considered not medically necessary. Cervical and thoracic discography are determined to have insufficient evidence in the published peer‑reviewed literature to support their use. Last review: 2024-05-24.
Medical Necessity Determinations
Policy / Criteria
Not Covered / Insufficient Evidence
Policy stance: Lumbar discography is not medically necessary because evidence shows the procedure is not safe or effective. Cervical and thoracic discography are considered to have insufficient evidence to support their use. The policy notes controversies about diagnostic accuracy and reliability, conflicting study results, lack of a gold standard, and potential for harm including accelerated disc degeneration; cervical and thoracic procedures specifically lack validation and controlled outcome studies.
Supporting evidence and safety considerations:
• Guideline/position: The North American Spine Society (NASS) supports use of lumbar discography for associating pain with moderate to severe disc degeneration but indicates insufficient evidence to predict surgical outcomes.
• Safety signal: A prospective cohort study suggests discography may lead to accelerated disk degeneration (new herniations, loss of disc height, and loss of disc signal intensity).
Relevant Codes
| 62290 | Injection procedure for discography, each level; lumbar. |
| 62291 | Injection procedure for discography, each level; cervical or thoracic. |
| 62292 | Injection procedure for chemonucleolysis, including discography, intervertebral disc, single or multiple levels, lumbar. |
| 72285 | Discography, cervical or thoracic, radiological supervision and interpretation. |
| 72295 | Discography, lumbar, radiological supervision and interpretation. |
Provider Actions & Billing Impact
Cervical and thoracic discography investigational/insufficient evidence
There is insufficient evidence in the published peer-reviewed literature to support the use of cervical and thoracic discography. Providers should recognize that use of the cervical and thoracic discography CPT codes may not meet medical necessity criteria under this policy.
Background & Evidence
Background: Discography is an invasive intradiscal diagnostic technique that injects contrast into a disc to reproduce pain and visualize disc morphology to help determine surgical candidacy. Lumbar discography is controversial with conflicting evidence about accuracy and reliability, absence of a clear gold‑standard reference test, and critics noting the test can provoke pain in persons without prior back pain. Studies disagree on its ability to identify the pain source or guide treatment. There is also evidence suggesting potential harms, including accelerated disc degeneration. Cervical and thoracic discography lack validation and controlled outcome studies, with few and poor‑quality publications, and are not appropriate diagnostic or screening tools for cervical or thoracic pain.
| Source | Summary |
|---|---|
| Guideline/Position (NASS) | NASS supports use of lumbar discography for associating pain with moderate to severe disc degeneration and endplate abnormalities on imaging but indicates insufficient evidence that discography predicts successful surgical outcomes. |
| Safety signal (prospective cohort study) | Evidence from a prospective cohort study suggests discography may lead to accelerated disk degeneration, including new herniations, loss of disc height, and loss of disc signal intensity. |
Discography: An invasive, intradiscal diagnostic technique using contrast injection and pain provocation to diagnose discogenic pain.
Revision History
Added clarifying language to Criteria I.
Replaced 'experimental/investigational' verbiage in policy statement II with 'there is insufficient evidence in the published peer-reviewed literature to support the use of cervical and thoracic discography.'
Policy split from CP.MP.63 Pain Management Procedures.
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