Neurosurgery Coding Alert

Question: CPT 2010 states that fluoroscopy is included with paravertebral facet joint injections, but one of our physicians says we can bill it separately. What's the latest information?

Nebraska Subscriber

Answer: You could bill 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, or sacroiliac joint], including neurolytic agent destruction) in conjunction with these injections through Dec. 31, 2009, but that's no longer the case.

Changes: CPT deleted codes 64470-64476 (Injection,anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve ...) in favor of new additions 64490- +64492 (Injection[s}, diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic ...) and 64493-+64495 (Injection[s}, diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar ...). The new codes became effective Jan. 1, 2010, and include fluoroscopy, so you cannot report the guidance in addition to the injection.