Radiology Coding Alert

Question: How should I report fluoroscopic guidance at the L5-S1 level?

Alabama Subscriber

Answer: If you're referring to a single puncture at the L5-S1 (lumbar 5-sacral 1) transition, then you should report one unit of 77003 (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).

AMA's CPT Assistant (December 2005) makes this clear, explaining that although the code is meant to be reported once per spinal region, you should report the code once for a single puncture such as at L5-S1.

(Note: The December 2005 article refers to code 76005. This code changed digits -- 77003 -- but not descriptor in 2007.)