Orthopedic Coding Alert

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


Texas Subscriber
Answer: Yes, you can report fluoroscopy with the pain management block; the correct code depends on the type of injection the physician administered.

If he performed a spine or paraspinous injection procedure, you should report 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).

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).

However, if he used fluoroscopy with another type of pain management injection such as fluoroscopic guidance for a sphenopalatine ganglion injection (64505) or an intra-articular ankle injection (20605), report 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) instead.
 
The key between these two codes is the injection location: spine/paraspinous versus non-spine/paraspinous.

Whichever fluoroscopy code applies, append modifier 26 (Professional component) unless your physician owns or leases the equipment and employs any technical staff.

In addition, many insurers do not allow ambulatory surgical centers to report fluoroscopy codes. Check with your insurer to determine whether your facility can report these procedures.