Neurology & Pain Management Coding Alert

Question: When using fluoroscopic guidance with more than one injection site, such as in facet blocks (64470-64476) or epidurals (62310-62319), how many times can we bill 76005 per claim?

Iowa Subscriber

Answer: Most payers allow 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) to be billed only once during a patient encounter, even when fluoroscopic guidance is used on separate sites. This is because the guidance system is set up once and additional significant work is not necessary when more than one site is addressed.

For example, if the neurologist performs a nerve block (64510) on the neck, he or she would bill 76005 for the fluoroscopic guidance. If, during the same examination, the neurologist performs an epidural injection to the sacral region again using fluoroscopic guidance, the only additional code would be 64483 for the epidural. Code 76005 would not be billed a second time despite the use of guidance in a different area.

It is possible, but unlikely, that fluoroscopic guidance could be billed twice on a given date of service for the same patient if medical necessity could be established for a second patient encounter. For example, if a patient who just underwent a procedure using fluoroscopic guidance was involved in a car accident on the way home and another procedure requiring fluoroscopic guidance was used to examine the new injuries, 76005 could be billed with each of the encounters.

Note: If fluoroscopy is performed in a facility, 76005 should be reported with modifier -26 for professional component only.