Anesthesia Coding Alert

Physicians often use fluoroscopy in conjunction with diagnostic procedures and injections to help pinpoint the correct area for a patient's treatment. Until recently, fluoroscopy could be billed separately from the primary procedure, but anesthesia providers and coders should note that is no longer the case.
 
When a procedure is considered an integral part of the comprehensive procedure being performed, the codes are often bundled together instead of paid separately. This is what happened with the fluoroscopy codes detailed below with current guidelines for their use.

Fluoroscopy Placement
The guidance for needle placement (76003, fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device) now includes 76005 (see full definition below) for guidance and localization of diagnostic or therapeutic injection procedures. The primary difference  between the two codes is that 76005 designates a procedure performed on the spine.
 
Many codes for injections that are often performed with fluoroscopy (such as 27096 [injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid]) can no longer be billed with fluoroscopy codes 76000 (fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or CPT 71034 [e.g., cardiac fluoroscopy]), 76001 (fluoroscopy, physician time more than one hour, assisting a non-radiologic physician [e.g., nephrostolithotomy, ERCP, bronchoscopy, transbroncial biopsy]) or 76003.
Fluoroscopic Guidance
The primary code for fluoroscopic guidance and localization (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) now includes 76001.
 
You can also no longer bill 76005 with a variety of injection and related codes, including 27096 (injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid), 62263 (percutaneous lysis of epidural adhesions using solution injection [e.g., hypertonic saline, enzyme] or mechanical means [e.g., spring-wound catheter] including radiologic localization [includes contrast when administered]), 62284* (injection procedure for myelography and/or computerized axial tomography, spinal [other than C1-C2 and posterior fossa]), 62287 (aspiration or decompression procedure, percutaneous, of nucleus pulposus of intervertebral disk, any method, single or multiple levels, lumbar [e.g., manual or automated percutaneous diskectomy, percutaneous laser diskectomy]), 62290* (injection procedure for diskography, each level; lumbar) and 62291* (... cervical or thoracic). Anesthesiologists, unlike radiologists, use fluoroscopy to assist them in performing a procedure. When a technique such as fluoroscopy becomes the standard of care for certain procedures, such as with neurolytic blocks or the injections listed above, it's common for the procedures to be bundled together. Similar situations exist for anesthesiologists with intravenous (IV) placement and intubation, which are included in the global anesthesia fee.
Fluoroscopy With Vertebroplasty
Two new vertebroplasty codes were introduced in CPT 2001. One of these codes specifies using fluoroscopic guidance (76012, radiological supervision [...]