# Fluoroscopic guidance billed with x-rays.  Unbundling???



## mdfoster (Feb 3, 2011)

When billing for an injections (ie facet joint injection , 64494, 64485) whereas fluoroscopic guidance is included in that code (according to CCI Edit), is a provider permitted to bill seperately for the diagnostic radiological exam (i.e. 72040, using the xray image intensifier)?  Wouldn't this be an integral part  of the fluoroscopic guidance?  Please provide any specific references indicating why or why not.

When billing for an injection (i.e., ESI 62311) which does not include fluoroscopic guidance and the flouroscopy can be billed separately (77003).  In this instance, is it also allowable to bill seperately for the diagnostic radiological exam (i.e. 72040, using the xray image intensifier)?  Would you expect that a hard copy of the produced images to report a diagnostic radiological exam?  

I cannot find any guidelines that says that this is not allowed.  However, it does not seem appropriate to me.  Thanks.


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## CatLaw (Feb 3, 2011)

I don't think you can bill for the diagnostic radiological exam along with the fluoroscopy. What is it the physician is doing that you would want to bill 72040?  When they are performing an LESI (62311) with fluoro, you would just bill 62311 and 77003 (26 modifier).  I have done pain management billing and coding for thirteen years and have never came across a situation where the 72040 would come up.  I am curious.  The xray intensifier should be included in 77003.  Let me know what you think!


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## dwaldman (Feb 3, 2011)

To me, it doesn't sound like you would not have a problem if you were doing a c spine x ray and lumbar facet block. But I would think the x ray would typically be done on something other than the fluoro machine such as a portable x ray or x ray with room specificially designated for x rays  that produces plain films. I am not exactly sure what an xray intensifier that you mentioned was.


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## marvelh (Feb 6, 2011)

FYI: Double check to make sure that the "diagnostic x-ray " is actually separate and distinct & not just the permanent film image of the fluoroscopic needle guidance.


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