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We have always billed fluoroscopy (77003-26) when billing LESI's (62311), however we are just now beginning to see denials that state the fluoro is now included in the injection. Has there been a change in this?
We do several of these a day too. There hasn't been any changes that I know of. The only pain management procedures that we perform that include guidance are tranforaminal & SI joint injections. I would look at that specific insurance carrier's policies to see where it states guidance is included. Be sure your Dr has clearly documented fluoro was used & a "permanent" image is in the patient's record. This way when you appeal it is very clear it was done & you should therefore be reimbursed for it.
There was a change a couple of years ago that 62311 includes "guidance". Some payers will pay both, others will not. If you use 72275-26 for epidurography as a diagnostic test to make sure there is no nerve root clumping, scarring or other conditions that would interfere with the therapeutic medications, and as noted above, you have to have a permanent image AND a separate report to get reimbursed. The reason for the change is research showed most LESI without guidance were mostly ineffective so guidance was necessary to get the best results. HOWEVER, epidurography can only be used once, and not for every subsequent injection.
The CPT change did not apply to 62310 or 62311. You can bill 62311 and 77003. But like it was stated, perhaps it could be a payer policy change. The best thing to do is pull the policy and find out.
Yoli
