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Anesthesia Coding Alert

READER QUESTIONS:

Confirm Spinal Block Location for Fluoro Code

Published on Sun Aug 21, 2005

Question: Can I report fluoroscopy in conjunction with pain management blocks? If so, what code do I use for the fluoroscopy?


Kansas Subscriber
Answer: Yes, you can report fluoroscopy with the pain management block; the correct code depends on the type of injection the physician administered. If he performed a spine or paraspinous injection procedure, report 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).

Examples of spine or paraspinous injections include a cervical epidural injection (62310, 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; cervical or thoracic) or a lumbar facet joint injection (64475, Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, single level]).
 
However, if he used fluoroscopy with another type of pain management injection such as fluoroscopic guidance for a sphenopalatine ganglion injection (64505) or an intra-articular ankle injection (20605), report 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) instead. The key between these two codes is the injection location: spine/paraspinous versus non-spine/paraspinous.

Whichever fluoroscopy code applies, append modifier 26 (Professional component) unless your physician owns/leases the equipment and employs any technical staff.
The documentation should briefly state that the physician used fluoroscopy. Many providers also include the various views from the procedure (such as anterior, posterior, lateral, etc.).  Answers to You Be the Coder and Reader Questions were provided by Marvel Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.
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