How To Use CPT Code 22527

CPT code 22527 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 22527?

CPT code 22527 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. CPT code 22527 is used when the procedure is performed on one or more additional levels, in addition to the primary procedure.

2. Official Description

The official description of CPT code 22527 is: ‘Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance one or more additional levels (List separately in addition to code for primary procedure).’ This code should be used in conjunction with CPT code 22526, which describes the primary procedure. It is important not to report codes 22526 and 22527 in conjunction with codes 77002 and 77003, which are related to imaging guidance.

3. Procedure

The percutaneous intradiscal electrothermal annuloplasty procedure involves several steps:

1. The patient is appropriately prepped for the procedure.
2. The provider uses fluoroscopic guidance to identify the target area for treatment.
3. A guidance needle is inserted into the annulus fibrosus, which is the fibrous outer ring of the intervertebral disk.
4. A catheter probe is passed over the guidance needle and into the annulus fibrosus.
5. The catheter is attached to a generator box, which heats the resistive element at the catheter’s tip.
6. The heat energy generated by the catheter coagulates or decompresses the disk material, providing relief from chronic back pain.
7. If necessary, the procedure may be performed on one or more additional levels after the primary procedure.

4. Qualifying circumstances

CPT code 22527 is used for patients with chronic back pain who require treatment with percutaneous intradiscal electrothermal annuloplasty. The procedure is performed by a provider using fluoroscopic guidance. It is important to note that Medicare does not cover thermal intradiscal procedures or services, and claims for this code may be denied. Providers should inform patients of their financial responsibility and have them sign an advance beneficiary notice (ABN) to avoid liability.

5. When to use CPT code 22527

CPT code 22527 should be used when the provider performs the percutaneous intradiscal electrothermal annuloplasty procedure on one or more additional levels, in addition to the primary procedure. It is important to report this code in conjunction with the appropriate primary code, CPT code 22526. However, it should not be reported with codes 77002 and 77003, which are related to imaging guidance.

6. Documentation requirements

To support a claim for CPT code 22527, the provider must document the following information:

• Patient’s diagnosis of chronic back pain
• Performance of the primary procedure using CPT code 22526
• Identification of the target area using fluoroscopic guidance
• Date and time of the procedure
• Details of the procedure, including the insertion of the guidance needle and catheter probe, and the application of heat energy
• Number of additional levels treated, if applicable
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 22527, ensure that the procedure is performed by a provider using fluoroscopic guidance. It is important not to report codes 22526 and 22527 in conjunction with codes 77002 and 77003. Providers should be aware that Medicare does not cover thermal intradiscal procedures or services and may deny claims for this code. To avoid liability, providers should have patients sign an advance beneficiary notice (ABN) if thermal intradiscal procedures are used in surgery.

8. Historical information

CPT code 22527 was added to the Current Procedural Terminology system on January 1, 2007. There have been no updates to the code since its addition. However, on January 1, 2010, the official description of the code was revised to include the phrase ‘one or more additional levels.’

9. Examples

1. A patient with chronic back pain undergoes percutaneous intradiscal electrothermal annuloplasty on two additional levels after the primary procedure.
2. A provider uses fluoroscopic guidance to perform percutaneous intradiscal electrothermal annuloplasty on one additional level for a patient with chronic back pain.
3. After performing the primary procedure on one level, a provider performs percutaneous intradiscal electrothermal annuloplasty on three additional levels using fluoroscopic guidance.
4. A patient with chronic back pain undergoes percutaneous intradiscal electrothermal annuloplasty on one additional level after the primary procedure.