Anesthesia Coding Alert

Question: Our physician used fluoroscopic guidance when he administered an epidural blood patch to help relieve a spinal headache. Can we code the guidance with the injection?

Washington Subscriber

Answer: Yes, you can report fluoroscopic guidance with the epidural blood patch. Choose 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, or sacroiliac joint], including neurolytic agent destruction) and submit it with 62273 (Injection, epidural, of blood or clot patch).

Contrast note: Although you can code the fluoroscopic guidance, CPT notes clearly state that 77003 includes injection of contrast. If your provider injects a bit of contrast to enhance visibility, you won't report a separate injection code for that.

Steer clear: 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) also represents fluoroscopic guidance, but excludes the spine. An epidural blood patch involves fluoroscopy of the spine, so 77003 is the correct choice.