Neurosurgery Coding Alert

Question: My physician used a 22-gauge needle to inject 1% Xylocaine and 80 mg of Depo-Medrol into the joint at the transverse process to the sacrum at the L5 transverse process over the sacrum. He used fluoroscopic guidance to guide the procedure. He wants to report 60605 and 76005, but I disagree. Are these codes correct?

Ohio Subscriber

Answer: No. You should not report 60605 (Excision of carotid body tumor; with excision of carotid artery) for this procedure. Instead, you should use 64475 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, single level).
 
Bonus: Your physician was correct that you should also separately report the fluoroscopic guidance. Use 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) for this service.
 
Append modifier 26 (Professional component) to indicate that the physician performed the professional but not technical component unless your office owns the fluoroscopic equipment.