Orthopedic Coding Alert

Question: Our orthopedic surgeon sometimes uses fluoroscopic guidance for wrist injections (such as 20526). Should we report the fluoroscopy code in addition to the injection code, or is one procedure included in the other?


Pennsylvania Subscriber

Answer: You should report 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) in addition to 20526 (Injection, therapeutic [e.g., local anesthetic, cortico-steroid], carpal tunnel).

The National Correct Coding Initiative (NCCI) does not bundle either procedure into the other, and most insurers will reimburse you for both procedures at the same visit.

If the surgeon uses fluoroscopic guidance with a ganglion cyst injection, however, you should not report 76003 separately, because the NCCI does bundle fluoroscopy into 20612 (Aspiration and/or injection of ganglion cyst[s] any location).
Caution: If the physician performs the wrist injection in any of the wrist joint spaces and uses contrast to obtain an arthrogram (with or without an associated therapeutic injection), don't use 76003.

Instead, you should use the radiological supervision and interpretation code for a wrist arthrogram (73115, Radiologic examination, wrist, arthrography, radiological supervision and interpretation).

You-ll also need to be sure that the physician obtains the correct series of plain films after contrast injection and submits a full report of the injection and the interpretation of the images.