Discography
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Policy governing coverage and medical necessity of discography (lumbar, cervical, thoracic) for members of health plans affiliated with Centene Corporation; affects providers requesting or performing discography for diagnostic evaluation of spinal pain.
No material clinical or coverage changes in this revision.
Coverage Determinations and Criteria
Coverage determinations
Policy statements
from Policy/Criteria I
from Policy/Criteria II
Cervical and thoracic discography are considered controversial because there is an absence of validation and controlled outcome studies, with limited and low-quality literature. For evaluation of cervical or thoracic pain, discography is not an appropriate diagnostic or screening tool.
Lumbar discography is considered not medically necessary because the procedure has evidence indicating it is not safe or effective.
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 |
| 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, Prior Authorization and Documentation
Documentation Expectations
Maintain complete clinical documentation to support medical necessity and to justify the request. Documentation should include patient history, prior conservative treatments attempted and their outcomes, findings on noninvasive imaging (e.g., MRI), rationale for discography, targeted disc levels, and planned use of results for clinical decision-making (for example, surgical planning). Include procedure reports, injection pressures if measured, and radiologic interpretation when applicable.
- Document prior nonoperative management and duration
- Include relevant imaging reports (MRI, X-ray)
- Record targeted levels and procedural details, including injection pressures and pain reproduction responses
- Attach radiology supervision and interpretation reports (if performed)
Denial Risk and Billing Impact
Providers should note that lumbar discography is considered not medically necessary per policy and may be denied if clinical documentation does not demonstrate clear justification; cervical and thoracic discography have insufficient evidence and may also be denied. Verify prior authorization approval before scheduling to avoid claim denials.
- Denial risk: lumbar discography (policy: not medically necessary)
- Denial risk: cervical and thoracic discography (insufficient evidence)
Definitions
Background
Discography is an invasive, intradiscal diagnostic test in which contrast is injected into an intervertebral disc under imaging guidance to reproduce the patient’s pain, visualize disc morphology, and assess injection pressures. The procedure is used to evaluate suspected discogenic pain but is controversial, particularly in the lumbar spine where proponents and critics differ on reliability, diagnostic validity, and potential harms; clinical consideration typically occurs only after other potential sources of lumbar pain have been excluded and when surgery is being considered.
Conservative Treatment and Exclusion Requirements
Other possible sources of lumbar pain should be excluded prior to consideration of discography.
Covered when ALL of the following are met:
Clinical context: consider exclusion of non-discogenic causes prior to discography
Background: test considered in the setting of surgical consideration
Imaging should not have confirmed source of discogenic pain
Imaging Requirements
Only consider discography if other imaging has not confirmed pain source
Do not proceed with discography when other imaging has already identified and confirmed the source of discogenic pain; discography is indicated only when other imaging has not confirmed the pain source.
- Policy was updated to require that other imaging must not have confirmed the source of discogenic pain prior to considering discography.
Not Covered / Not Medically Necessary
Lumbar discography is not covered — not medically necessary. Claims for lumbar discography are at risk for denial because the procedure is considered not safe or effective based on the evidence reviewed.
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