Carrier Update:
Check Your Pay for Fluoro Guidance With Spinal Injections
Published on Thu Sep 09, 2004
Will your carrier follow Aetna's lead? Aetna made a move this summer that was well received by anesthesia and pain management providers: The carrier reversed its non-payment policy of fluoroscopic guidance for spinal and paraspinal injections.
The carrier previously considered guidance to be the standard of care for performing these injections, which meant they didn't separately reimburse for 76005 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint], including neurolytic agent destruction).
This position changed effective August 15, 2004, thanks to input from the American Society of Anesthesiologists and other groups. The only exceptions will be when the procedure's descriptor includes imaging or when the physician uses the fluoroscopy to facilitate more intense imaging procedures.
Earlier this year, McKesson Information Solutions - the company that provides code-bundling software to many Blue Cross/Blue Shield licensees and other private health plans - announced that it would discontinue the "edits" that bundle 76005 with many injection codes.