Eli's Rehab Report

Published on Thu Jun 09, 2005 PDF

Question: Should I always report only one unit of 76005 regardless of the number of injections?


Tennessee Subscriber

Answer: Yes. If your physiatrist provides the fluoroscopic guidance that allows her to place the needle for facet joint injections, you should report a single unit of 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), regardless of how many injections the physiatrist administers under fluoroscopic guidance.

As Noridian Medicare guidelines point out, the descriptor for 76005 specifies " 'for injection procedures' (plural), and so may be billed only once regardless of the number of levels addressed" (emphasis in original).

However, the September 2002 AMA CPT Assistant states that "76005 is intended to be reported per spinal region (e.g., cervical, lumbar) and not per level." Theoretically, if a provider performs a cervical procedure and a lumbar procedure with fluoroscopic assistance, he could report both services. But in reality, some payers will only reimburse one unit of 76005 per date of service. 

Main key: Multiple procedures in the same region equal one unit of 76005, which occurs more frequently than multiple regions.

As for modifiers, you needn't append modifier -51 (Multiple procedures) when reporting 76005, but you should append modifier -26 (Professional component) if the physiatrist:

1. only interprets the results of the fluoroscopy

2. performs the procedure in a facility site of service such as an outpatient hospital facility/ASC, or

3. uses equipment that he does not own/lease.

The facility will bill separately, appending modifier -TC (Technical component) to receive compensation for use of its equipment and technical staff.