Cervical Discectomy Checklist

Published 06/04/2021

A Cervical Discectomy is a type of neck surgery that involves removing a damaged disc to relieve spinal cord or nerve root pressure and alleviate corresponding pain, weakness, numbness, and tingling. Documentation Requirements for cervical discectomy includes:




Indicate if this request is an expedited review for cervical discectomy


Documentation submitted supports a condition or diagnosis for cervical discectomy



The procedure requested is indicated for cervical generative disc disease C3 to C7



Documentation supports that conservative treatments have been attempted for 6 weeks for intractable cervical pain or myelopathy



The patient has severe or rapidly progressive symptoms of nerve root or spinal cord compression requiring immediate surgical intervention



Documentation submitted support pain characteristics and/or interference with activities of daily living (ADLs)



Physician order for the procedure/device



Documentation supports that conservative treatments have been tried and failed

Oral steroid therapy




Physical therapies


Epidural block


Reduced activity



Other — Please list



Documentation includes radiological evidence of nerve root or spinal cord compression (CT scan, MRI or Myelography)





Does the beneficiary have any contraindications to cervical discectomy?


Extreme obesity (BMI of 40 of greater)


Significant cervical anatomical deformity


Allergy or sensitivity to implant materials



Active systemic infection at the operating site



Osteoporosis or osteopenia



Marked cervical instability



Severe spondylosis



Clinically compromised vertebral bodies at affected level





Was this article helpful?