Anesthesia Coding Alert

Increase your reimbursement by reporting both codes

Anesthesia coders have debated it for years with insurers, but now it's official: Fluoroscopic guidance is not bundled into spinal injection procedures - and the American Society of Anesthesiologists (ASA) recently put that advice in writing.

In a December 2003 memo, the ASA explained that you can 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) and the spinal injection procedures separately. Refer to CPT CPT states that "Injection of contrast during fluoroscopic guidance and localization is an inclusive component of codes 62263, 62264, 62270-62273, 62280-62282, 62310-62319, 0027T. Fluoroscopic guidance and localization is reported by code 76005 unless a formal contrast study (myelography, epidurography or arthrography) is performed, in which case, the use of fluoroscopy is included in the supervision and interpretation codes."

Basically, what that means is that although the injection of contrast is included in the spinal injections listed, fluoroscopic guidance is not.

Part of the confusion regarding the two procedures stems from the thousands of NCCI (National Correct Coding Initiative) edits published each quarter. Fluoroscopy is bundled with some procedures - which means you cannot report them separately - but no edits to date bundle 76005 with any spinal injection codes.

Log on to the ASA's Web site (www.asahq.org) to read the entire memo.