Neurology & Pain Management Coding Alert

If your neurologist provides the fluoroscopic guidance that allows her to place the needle for facet joint injections, don't forget to report the guidance using 76005.

Be aware, however, that you should report a single unit of 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), regardless of how many injections the neurologist administers under fluoroscopic guidance.
 
As Noridian Medicare guidelines point out, the descriptor for 76005 specifies, " 'for ... injection procedures' (plural), and so may be billed only once regardless of the number of levels addressed" (emphasis in original).

In addition, you needn't append modifier -51 (Multiple procedures) when reporting 76005, but you should append modifier -26 (Professional component) if the neurologist:

1. only interprets the results of the fluoroscopy

2. performs the procedure in a hospital facility, or

3. uses equipment that he does not own.

The facility will bill separately, appending modifier -TC (Technical component) to receive compensation for use of its equipment.