Neurology & Pain Management Coding Alert

Question:  Do payers allow you to report fluoroscopy in conjunction with an interlaminar epidural block? If so, how do I code the fluoroscopy?

Oregon Subscriber

Answer: You can report fluoroscopic guidance with some injection procedures your pain management specialist might perform, including interlaminar epidural blocks.

Remember: Report an interlaminar epidural injection just as you would a single epidural injection. Code the procedure based on the injection location, with either 62310 (Injection[s], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic) or 62311 (… lumbar, sacral [caudal]).

Revised guidelines introduced in CPT^® 2012 state, "Fluoroscopy (for localization) may be used in the placement of injections reported with 62310-62319, but is not required. If used, fluoroscopy should be reported with 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural or subarachnoid])."

Caveat: The descriptors for some injection procedures include fluoroscopy, so in those instances you won’t separately report 77003. For example, codes 64490-64495 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT] …) include fluoroscopic or CT guidance.

If your provider administers the injection in a facility, append modifier 26 (Professional component) to the fluoroscopic guidance code since your physician does not own or lease the equipment and employ the technical staff. Your provider’s documentation should briefly state that he used fluoroscopy for needle guidance.