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.

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.

Two new vertebroplasty codes were introduced in CPT 2001. One of these codes specifies using fluoroscopic guidance (76012, radiological supervision and interpretation, percutaneous vertebroplasty, per vertebral body; under fluoroscopic guidance), and now includes all other fluoroscopy codes (76000-76005). The other vertebroplasty code, 76013 ( under CT guidance), is not affected by the fluoroscopy bundlings since it specifies that the procedure is performed under CT and fluoroscopy is not used.

"There are two schools of thought associated with the use of fluoroscopy, and evidently, there has been quite a bit of debate among physicians on this topic," says Gail Kaye, CPC, a coder with the consulting firm Webster, Rogers and Co., LLP, in Florence, S.C. "Some use fluoroscopy and insist that treatment of the area is more effective because they are able to inject the area in question more accurately. But I have also talked with doctors who have never used fluoroscopy for the procedures. Obviously, the impact on reimbursement for doctors who continue to use fluoroscopy with injections despite the edits will be significant, because they'll no longer be getting paid for two codes."
 
"This is a big change for some practices," notes Lewis Woodell, director of reimbursement and compliance in the anesthesia billing office of Summit Healthcare in Fort Worth, Texas. "It remains to be seen how bundling these codes will affect the big picture."
 
However, some anesthesia professionals don't believe that the newly bundled codes should affect practitioners very much. Their stance is that anesthesiologists perform fluoroscopic guidance, not radiology procedures. Because many of the codes related to fluoroscopy deal with radiology, these practitioners say that 76005 is the only code that anesthesiologists should have been using in the first place multiple codes should never have been billed.