Neurology & Pain Management Coding Alert

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

Florida Subscriber

Answer: Yes, you can report fluoroscopic guidance with most of the pain management injection codes. Your  ode 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).

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).

If the injection was performed in a facility site of service, you will need to append modifier 26 (Professional component) to the fluoroscopic guidance code as your physician does not own/lease the equipment and employ the technical staff. Your provider's documentation should briefly state that fluoroscopy was used for needle guidance.