Radiology Coding Alert

Question: Our physician provided fluoroscopic guidance for injections into the elbow joint and the middle interphalangeal joint in the right finger. How can we report this service?

North Carolina Subscriber

Answer: For the fluoroscopic guidance, you submit code 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]…). Your physician is providing the fluoroscopic guidance for injection procedures in two joints, the elbow joint and the middle interphalangeal joint. You can hence submit 2 units of code 77002.

On the claim, you can submit codes for the injection procedures if your physician also performed these. The codes for injection procedures include 20605 (Arthrocentesis, aspiration and/or injection, intermediate joint or bursa [e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa]; without ultrasound guidance) for the elbow injection and 20600 (…  small joint or bursa [e.g., fingers, toes]; without ultrasound guidance) for the finger joint injection. You may want to check with your payers and append modifier RT (Right side).>

Modifier 51: To specify that the guidance and injections are separate procedures, you can also append modifier 51 (Multiple procedures) to the injection codes. You may want to confirm with your payer any applicable policies on coding fluoroscopic guidance with the injection procedures.