Anesthesia Coding Alert

Question: Can I report fluoroscopy in conjunction with a spinal block? If so, how do I code the fluoroscopy?

Florida Subscriber

Answer: Yes, you can report fluoroscopic guidance with most pain management injection procedures, including spinal blocks. Your code selection will depend on the type of injection the physician administered.

If your physician performed a spine or paraspinous injection procedure, report 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).

CPT change: The descriptor for 77003 changes in CPT 2010 to reflect the addition of new codes 64490- 64495 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [xygaphphyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT]...). Double-check the descriptors to ensure you code correctly after Jan. 1, 2010. Codes 64990-64995 include fluoroscopy, so you shouldn't code it separately.

One example of a spinal block includes 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).

If your provider administers the injection in a facility, append modifier 26 (Professional component) to the fluoroscopic guidance code since your physician does not own or lease the equipment and employ the technical staff.

Your provider's documentation should briefly state that he used fluoroscopy for needle guidance.