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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 involves the use of a catheter that is inserted into the intervertebral disc, specifically targeting the disc annulus or nucleus. The procedure begins with the identification of the affected disc through a process known as discography, which helps to pinpoint the source of pain. Once the target disc is located, a specialized spinal catheter equipped with a thermal resistive coil is carefully positioned within the disc. The catheter is maneuvered in a circuit-like fashion, passing through the disc and exiting posteriorly. During the procedure, electrothermal heat is generated via the coil, which heats the disc material to approximately 90 degrees centigrade for a duration of about 20 minutes. It is important to note that this heating process does not result in the destruction, burning, or ablation of the tissue. 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. For coding purposes, CPT® Code 22526 is used for a single level of the procedure, while CPT® Code 22527 is designated for one or more additional levels, either unilaterally or bilaterally, performed in conjunction with the primary level. Fluoroscopic guidance is included as part of the procedure to ensure accurate placement of the catheter.
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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 options. The goal of the procedure is to provide pain relief and improve functional outcomes for individuals suffering from these specific spinal conditions.
The percutaneous intradiscal electrothermal annuloplasty procedure involves several key steps to ensure effective treatment of the targeted disc. First, the physician performs discography to identify the specific disc that is causing pain. This imaging technique allows for the assessment of the disc's condition and helps in determining the appropriate level for intervention. Once the target disc is identified, the physician prepares the patient and the necessary equipment for the procedure.
Following the percutaneous intradiscal electrothermal annuloplasty, patients may experience some discomfort at the site of the procedure, which is typically manageable with over-the-counter pain relief medications. It is essential for patients to follow any post-procedure care instructions provided by their healthcare provider, which may include activity restrictions and recommendations for physical therapy. The expected recovery time can vary, but many patients report gradual improvement in pain levels over the weeks following the procedure. Regular follow-up appointments may be scheduled to monitor the patient's progress and assess the effectiveness of the treatment.
| Short Descr | IDET 1 OR MORE LEVELS | Medium Descr | PERQ INTRDSCL ELECTROTHRM ANNULOPLASTY ADDL LVL | Long Descr | Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; 1 or more additional levels (List separately in addition to code for primary procedure) | Status Code | Non-Covered Service | Global Days | ZZZ - Code Related to Another Service | 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 an add-on code that must be used in conjunction with one of these primary codes.
| 22526 | MPFS Status: Non-covered Service APC E1 Physician Quality Reporting CPT Assistant Article Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level |
| 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. | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | LT | Left side (used to identify procedures performed on the left side of the body) |
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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. Guideline information changed. |
| 2010-01-01 | Changed | Code description changed. |
| 2007-01-01 | Added | First appearance in code book in 2007. |
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