Anesthesia Coding Alert

With only two choices available, coding fluoroscopy associated with nerve blocks or destruction should be straightforward. However, the two options are a challenge: 76000 (fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) and 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).

Code 76005 was introduced in CPT 2000 but is still a new code to many of us, according to Carla Thibodeaux, CPC, an anesthesia coder with the 75-anesthesiologist group Tejas Anesthesia in San Antonio. So many new pain codes were introduced last year that were still learning which to use when. Weve been so accustomed to using 76000 for any fluoroscopy that its sometimes hard to remember that we cant automatically code that way anymore. Now we have the challenge of picking apart the procedure notes to determine which fluoroscopy codes go with which procedures.

Use Location as Coding Clue

The injection location is the primary clue for determining which fluoroscopy block code is accurate. For example, if the injection is administered to any area of the spine, including the sacroiliac joint, use 76005. If the block is administered to an area other than the back, use code 76000. Examples follow:

Intercostal nerve blocks, brachial plexus blocks and stellate ganglion blocks fall under 76000 because they are all pain procedures.

Lumbar, paravertebral or sacroiliac joint blocks to treat back pain are coded with 76005. Including sacroiliac joint injections with code 76005 might confuse some coders, Thibodeaux says, because they dont think of the sacroiliac joint as part of the spine.

Revision or removal of peripheral neurostimulator electrodes (64585) is a procedure that falls under fluoroscopy 76005.

For nerve blocks, common procedural codes to bill along with 76005 include 64470-64484 (codes related to various levels and sites of injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve). Codes 64400*-64450* (codes related to different nerves for injection, anesthetic agent) still go with 76000.

Consider More Coding Contingencies

Epidurography: This procedure presents another anesthesia coding challenge. The primary ASA code for anesthesia during an epidurography (72275, epidurography, radiological supervision and interpretation) is 01922 (anesthesia for noninvasive imaging or radiation therapy). Two other coding options depend on the anesthesiologist. If it is determined that it would not be a routine procedure, append modifier -23 (unusual anesthesia). And, if either the surgeon or anesthesiologist chooses MAC for the procedure, you would have to code accordingly.

You must file a formal report to submit codes 76005 or 76000 with 72275. But, [...]