Anesthesia Coding Alert

Use these 3 tips to help educate your carriers  

 Correctly billing fluoroscopic guidance with spinal injections is an ongoing debate between some carriers and providers. If you -- or your carriers -- are still confused about how to report these procedures, read on for some expert guidance.

The Number Changed, Not the Use 

 CPT Codes 2007 introduced a new "Radiologic Guidance" section, including three fluoroscopic guidance codes. These codes, however, are only new in terms of their numbers -- not their descriptors. CPT deleted the old guidance codes and created new numbers for the same procedures to group them together.

 The guidance code of note for anesthesiologists and pain management specialists is 77003 (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). It has the same descriptor as deleted code 76005. The service is identical to what 76005 represented, and the coding and reimbursement guidelines also remain the same.

 What that means: CPT states that some spinal injection procedures include contrast injection, but not the fluoroscopic guidance and localization. Based on the code descriptor and the CPT guidelines, you can report fluoroscopic guidance separately from spinal injection procedures, states a recent memo from the American Society of Anesthesiologists. These spinal procedures include:

• 62270-62272 -- Spinal puncture ... 
• 62273 -- Injection, epidural, of blood or clot patch
• 62280-62282 -- Injection/infusion of neurolytic substance (e.g., alcohol, phenol, iced saline solutions), with or without other therapeutic substance ...
• 62310-62311 -- Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid ...
• 62318-62319 -- Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid ...
• 64470-64476 -- Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve ...
• 64479-64484 -- Injection, anesthetic agent and/or steroid, transforaminal epidural ...
• 64622-64627 -- Destruction by neurolytic agent, paravertebral facet joint nerve ... 

CCI Does Not Bundle the Procedures 

 National Correct Coding Initiative (CCI) edits also work in your favor when coding fluoroscopic guidance with spinal injections.

 Medicare and many private payers follow CCI guidelines to determine whether providers can perform certain procedures during the same patient encounter or whether one procedure includes the work of another, says Barbara J. Johnson, CPC, MPC, owner of Real Code Inc. in Moreno Valley, Calif. No CCI edits bundle 77003 with spinal injection codes 62270-62273, 62280-62282 or 62310-62319, which means you can report both services by your physician.

Procedure RVUs Don't Include Fluoro 

 Every CPT procedure has "work values" assigned to it as a way to guide reimbursement. These amounts -- called relative value units, or RVUs -- correspond to the procedure's difficulty level.

 Fluoroscopic guidance code 77003 includes 0.6 RVUs for physician work. The spinal injection RVUs aren't high enough to include fluoroscopic guidance.

 How you know: If you look at a procedure's RVUs and subtract 0.6 for fluoroscopic guidance, the result would be the RVUs for the procedure alone. Subtracting 0.6 from spinal injection procedures leaves RVUs that don't accurately reflect the spinal injection work. 

 Example: Epidural code 62311 has a physician work RVU of 1.54. Deducting 0.6 for fluoroscopic guidance leaves an RVU of 0.94 ��" which would make the epidural injection comparable to the RVUs for a carpal tunnel injection (20526, Injection, therapeutic [e.g., local anesthetic, corticosteroid], carpal tunnel) or removal of a foreign body from the external eye (65222, Removal of foreign body, external eye; corneal, with slit lamp). The epidural injection is much more complex than these procedures, so it should have a higher RVU. You reach the higher RVU by reporting the fluoroscopic guidance separately.

 Follow-up: For more information on reporting fluoroscopic guidance with spinal injection procedures, visit the American Society of Anesthesiologists' Web site at www.asahq.org.