Neurology & Pain Management Coding Alert

Question: Do payers allow you to report fluoroscopy in conjunction with an interlaminar epidural block? If so, how do I code the fluoroscopy?

Oregon Subscriber

Answer: You can separately report fluoroscopic guidance with some injection procedures your pain management specialist might perform, including:

• 62267 (Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or paravertebral tissue for diagnostic purposes)
• 62310-62311 (Injection[s], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid ...)
• 62318-62319 (Injection[s], including indwelling catheter placement, continuous infusion or intermittent bolus of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid ...).

Revised guidelines in CPT® 2012 state that you can report fluoroscopy for localization when the provider administers injections reported with 62310-62319, but is not required. If your provider uses fluoroscopy, report 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural or subarachnoid]). You should also report 77003 for guidance associated with 62267.

Remember: The descriptors for some injection procedures include fluoroscopy, so in those instances you won't separately report 77003. For example, codes 64490-64495 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT]...) include fluoroscopic or CT guidance.

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.