How To Use CPT Code 22526

CPT code 22526 describes the percutaneous intradiscal electrothermal annuloplasty procedure, which is used to treat chronic back pain. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 22526?

CPT code 22526 is used to describe the percutaneous intradiscal electrothermal annuloplasty procedure. This procedure involves the application of heat energy through a needle inserted into an intervertebral disk to treat chronic back pain. The provider uses fluoroscopic guidance, which is live X-ray imaging, to accurately guide the application of the treatment on one or both sides of the disk.

2. Official Description

The official description of CPT code 22526 is: ‘Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance single level.’

3. Procedure

During the percutaneous intradiscal electrothermal annuloplasty procedure, the provider first preps the patient appropriately. They then use fluoroscopic guidance to identify the target area within the intervertebral disk. A guidance needle is inserted over which a catheter probe is passed into the annulus fibrosus, which is the fibrous outer ring of the intervertebral disk. The catheter is attached to a generator box, which heats the resistive element at the catheter’s tip. This heat energy is used to coagulate or decompress the disk material, providing relief from chronic back pain.

4. Qualifying circumstances

CPT code 22526 is used for patients with chronic back pain who require treatment through percutaneous intradiscal electrothermal annuloplasty. The procedure is performed by a provider using fluoroscopic guidance. It can be performed unilaterally or bilaterally, depending on the specific needs of the patient.

5. When to use CPT code 22526

CPT code 22526 should be used when a provider performs percutaneous intradiscal electrothermal annuloplasty to treat chronic back pain. It is important to ensure that the procedure is performed using fluoroscopic guidance and that it is documented as being performed on a single level. If the procedure is performed on multiple levels, separate codes should be used for each level.

6. Documentation requirements

To support a claim for CPT code 22526, the provider must document the following information:

• Patient’s diagnosis of chronic back pain
• Documentation of the use of fluoroscopic guidance
• Specific level of the intervertebral disk treated
• Date of the procedure
• Procedure notes detailing the steps taken during the percutaneous intradiscal electrothermal annuloplasty
• Any complications or adverse events that occurred during or after the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 22526, it is important to ensure that the procedure meets the specific requirements outlined in the code description. The use of fluoroscopic guidance and the performance of the procedure on a single level should be documented. It is also important to note that Medicare does not cover thermal intradiscal procedures or services, and claims for this code may be denied. Providers should inform beneficiaries of their financial responsibility prior to performing the procedure and have them sign an advance beneficiary notice (ABN) to avoid liability.

8. Historical information

CPT code 22526 was added to the Current Procedural Terminology system on January 1, 2007. There have been no updates to the code since its addition.

9. Similar codes to CPT 22526

There are several similar codes to CPT code 22526 that are used to describe other percutaneous augmentation and annuloplasty procedures. These include:

• CPT 22527: Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; each additional level (List separately in addition to code for primary procedure)

9. Examples

1. A patient with chronic back pain undergoes percutaneous intradiscal electrothermal annuloplasty on a single level using fluoroscopic guidance.
2. A provider performs percutaneous intradiscal electrothermal annuloplasty bilaterally on two levels of the intervertebral disk to treat chronic back pain.
3. Using fluoroscopic guidance, a provider performs percutaneous intradiscal electrothermal annuloplasty on a single level for a patient with chronic back pain.
4. A patient with chronic back pain undergoes percutaneous intradiscal electrothermal annuloplasty unilaterally on a single level using fluoroscopic guidance.
5. A provider performs percutaneous intradiscal electrothermal annuloplasty on a single level using fluoroscopic guidance for a patient with chronic back pain.
6. Using fluoroscopic guidance, a provider performs percutaneous intradiscal electrothermal annuloplasty bilaterally on a single level for a patient with chronic back pain.
7. A patient with chronic back pain undergoes percutaneous intradiscal electrothermal annuloplasty unilaterally on two levels of the intervertebral disk using fluoroscopic guidance.
8. A provider performs percutaneous intradiscal electrothermal annuloplasty on a single level using fluoroscopic guidance for a patient with chronic back pain.
9. Using fluoroscopic guidance, a provider performs percutaneous intradiscal electrothermal annuloplasty bilaterally on a single level for a patient with chronic back pain.
10. A patient with chronic back pain undergoes percutaneous intradiscal electrothermal annuloplasty unilaterally on a single level using fluoroscopic guidance.