Clinical Policy: Discography
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Defines medical necessity and coverage stance for lumbar, cervical, and thoracic discography for members of Health Net (Centene-affiliated health plans). Applies to providers requesting or performing discography procedures.
No material clinical or coverage changes in this revision.
Coverage Determinations
Not Medically Necessary - Lumbar Discography
Covered when ALL of the following are met:
Explicit policy statement
Insufficient Evidence - Cervical/Thoracic Discography
Covered when ALL of the following are met:
Explicit policy statement
For cervical and thoracic pain, discography is not an appropriate diagnostic or screening tool. The published literature for cervical and thoracic discography is limited, lacks validation and controlled outcome studies, and includes few and generally poor-quality studies, so these procedures remain controversial and unsupported for routine diagnostic use.
Lumbar discography is considered not medically necessary because the policy concludes there is evidence the procedure is not safe or effective. In addition to limited effectiveness, the literature reports potential harms associated with lumbar discography, including evidence it may accelerate disk degeneration manifested by new herniations, loss of disc height, and loss of disc signal intensity.
Procedure 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 Requirements & Notifications
Prior authorization required — discography CPTs subject to coverage review
Procedures coded with CPT codes 62290, 62291, 62292, 72285, and 72295 are subject to the policy's coverage criteria; lumbar discography is considered not medically necessary and prior authorization requests for lumbar discography would be expected to be denied.
Confirm exclusion of other lumbar pain sources before testing
Documenters should ensure the clinical record notes that other possible sources of lumbar pain were considered and excluded before requesting discography and that surgery is being considered, as discography is intended as a diagnostic test after other causes are excluded.
- Document that other possible sources of lumbar pain were evaluated and excluded prior to discography.
- Document that discography is being considered in the context of possible surgical management.
Documentation expectations for discography requests
Providers must document prior exclusion of other sources of lumbar pain and the clinical rationale for performing discography, including that the test is being used to reproduce the patient's pain and to assess disc morphology and injection pressures.
- Record findings from prior imaging and clinical evaluation that exclude other causes of lumbar pain.
- Include rationale that discography is intended to reproduce the patient's pain, visualize disc morphology, and consider injection pressures in interpretation.
High denial risk — lumbar (and limited support for cervical/thoracic)
Requests for lumbar discography will be denied as not medically necessary; cervical and thoracic discography have insufficient evidence in the peer-reviewed literature and may be denied pending local determination.
- Lumbar discography: considered not medically necessary and expected to be denied.
- Cervical/thoracic discography: insufficient evidence to support use; may be denied.
Prior Conservative Management
Other possible sources of lumbar pain should be excluded prior to consideration of discography.
Requirement prior to consideration of discography:
Typically document exclusion of non-discogenic causes and that surgery is being considered
Imaging Prior to Discography
Verify imaging did not confirm discogenic pain source
Ensure prior imaging has not already identified the source of discogenic pain; discography should only be considered when other imaging has not confirmed the symptomatic disc and other sources of lumbar pain have been excluded.
- Confirm prior imaging (e.g., MRI, radiographs) did not definitively identify the symptomatic disc.
- Document that discography is being considered only after imaging failed to confirm the source of discogenic pain.
Background and Scope
Discography is an invasive, intradiscal diagnostic test in which contrast medium is injected into an intervertebral disc under imaging to attempt to reproduce a patient’s pain, evaluate disc morphology, and assess injection pressures as part of interpreting whether a disc is the source of pain. Because it is invasive and intended to provoke pain for diagnostic purposes, its use is considered only after other potential sources of lumbar pain have been excluded and when surgical consideration is being weighed.
Key Definitions
Non-Covered Services
Requests for lumbar discography are considered not medically necessary and will not be covered under this policy.
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