When to use CPT code 22526 and 22527

Description of CPT code 22526 and 22527

Percutaneous intradiscal annuloplasty is a minimally invasive technique performed under fluoroscopic guidance to treat small tears in the annulus without an associated disc protrusion. The most common technique is intradiscal electrothermal therapy (IDET). In IDET, the physician advances a needle into the disc using x-ray image guidance. The appropriate treatment catheter is selected and inserted through the needle. Once the catheter is in position, the temperature of the heating portion of the catheter is increased gradually, raising the temperature of the affected site. The increased heat contracts and thickens the collagen disc wall, which may result in contracture and closure of the tears in the annulus. The physician may perform the procedure on one (unilateral) or both sides of the disc.

CPT code 22526 is reported when a single disc is treated and code 22527 is reported for one or more additional discs.

22526 Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level

+22527 1 or more additional levels (List separately in addition to code for primary procedure)

Both codes 22526 and 22527 includes the fluoroscopic guidance and hence the Fluoroscopy should not be coded separately along with these CPT codes.

72285 Discography, cervical or thoracic, radiological supervision and interpretation

72295 Discography, lumbar, radiological supervision and interpretation

Coding tips: Fluoroscopic guidance is included in the procedure and radiological supervision and interpretation codes. When radiologist perform these services independently from the physician performing the injection procedure like , discography code 72285 and 72295 are coded. But both Fluoroscopic guidance (code 77003) and R&I codes should never be coded together. You can see the herirachy below an example.

62290>72295>77003

Question: When performing the intradiscal electrothermal annuloplasty procedure (also known as intradiscal electrothermal therapy), is it appropriate to separately report the performance of a discography?

Answer: No, it is not appropriate to separately report code 72285, Discography, cervical or thoracic, radiological supervision and interpretation, or 72295, Discography, lumbar, radiological supervision and interpretation, and code 22526, Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level, for the same operative session. Fluoroscopy is included in the discography imaging codes. As a general rule, if fluoroscopy has been or is normally known to be performed as part of the radiological imaging study, fluoroscopy would have been included in the codes for radiological imaging so that it is not separately reported.