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Percutaneous intradiscal electrothermal annuloplasty is a minimally invasive procedure designed to alleviate chronic low back pain associated with disc pathology. This technique utilizes a catheter-based approach, allowing for targeted treatment of the affected intervertebral disc. Initially, the specific disc requiring intervention is identified through a process known as discography, which helps to confirm the source of pain. A specialized spinal catheter, equipped with a thermal resistive coil, is then carefully inserted into the disc annulus or nucleus. The catheter is maneuvered through the disc in a circuit-like fashion, exiting posteriorly. Once positioned correctly, the thermal coil generates electrothermal heat, which is applied to the disc material for approximately 20 minutes at a controlled temperature of 90 degrees centigrade. Importantly, this heating process does not result in tissue destruction, burning, or ablation. Instead, the application of heat is believed to provide pain relief by causing the collagen fibers within the disc to shrink and by thermocoagulating the adjacent nerve tissue or pain receptors. This procedure is reported using CPT® Code 22526 for a single level, whether performed unilaterally or bilaterally, with fluoroscopic guidance included as part of the process.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure of percutaneous intradiscal electrothermal annuloplasty is indicated for patients experiencing chronic low back pain that is attributed to disc pathology. This may include conditions such as herniated discs, degenerative disc disease, or other disc-related issues that have not responded adequately to conservative treatment methods.
The procedure begins with the identification of the target disc through discography, which is essential for confirming the source of the patient's pain. Once the disc is located, a specialized spinal catheter is introduced. This catheter features an embedded thermal resistive coil and is inserted posterolaterally into the disc annulus or nucleus. The catheter is then maneuvered through the disc in a circuit-like manner, exiting posteriorly. After proper placement, the thermal coil is activated to generate electrothermal heat. This heat is applied to the disc material for a duration of approximately 20 minutes, maintaining a temperature of 90 degrees centigrade. It is crucial to note that this heating process is designed to avoid tissue destruction, burning, or ablation. Instead, the heat serves to shrink collagen fibers and thermocoagulate adjacent nerve tissue or pain receptors, thereby providing pain relief. The entire procedure is performed under fluoroscopic guidance to ensure accurate catheter placement and monitoring.
After the completion of the percutaneous intradiscal electrothermal annuloplasty, patients may experience some discomfort at the site of the procedure, which is typically manageable with standard pain relief measures. It is important for patients to follow any post-procedure care instructions provided by their healthcare provider, which may include activity restrictions and recommendations for follow-up appointments. The expected recovery time can vary, but many patients may begin to notice improvements in their pain levels within a few weeks following the procedure. Continuous monitoring and assessment of the patient's response to treatment are essential to ensure optimal outcomes.
| Short Descr | IDET SINGLE LEVEL | Medium Descr | PERQ INTRDSCL ELECTROTHRM ANNULOPLASTY 1 LEVEL | Long Descr | Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level | Status Code | Non-Covered Service | Global Days | 010 - Minor Procedure | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Non-Covered Service, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 0 | CCS Clinical Classification | 9 - Other OR therapeutic nervous system procedures |
This is a primary code that can be used with these additional add-on codes.
| 22527 | Addon Code MPFS Status: Non-covered Service APC E1 CPT Assistant Article Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; 1 or more additional levels (List separately in addition to code for primary procedure) |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | GC | This service has been performed in part by a resident under the direction of a teaching physician | KX | Requirements specified in the medical policy have been met | LT | Left side (used to identify procedures performed on the left side of the body) | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| 2011-01-01 | Changed | Short description changed. |
| 2007-01-01 | Added | First appearance in code book in 2007. |
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