ASA supports fluoro as fully separate, billable service


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I received this in a email from Decision Health's Anesthia e-zine today and wanted to forward it along. I know I have read some thread/posts concerning this issue. Decision Health has free e-zines (email updates) in many different specialities, Anesthesia and pain management being one of them.

ASA supports fluoro as fully separate, billable service
We've told you before, but now the American Society of Anesthesiology (ASA) has thrown its considerable medical standing behind the issue: Fluoroscopic guidance for spinal injections is a separately payable service.

“ASA has received reports of much payer confusion as to whether fluoroscopic guidance is bundled into spinal injection procedures. It is not,” says ASA in its Fluoroscopic Guidance for Spinal Injections, practice guidelines that were approved by the ASA House of Delegates in October 2007.

The confusion started because the fluoroscopy codes were renumbered in CPT last year, but the definitions were left unchanged. Code 76005 was renumbered as 77003 [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]; 76003 was renumbered as 77002 [fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device)].

ASA points to the CPT book itself to support its rationale that fluoroscopic guidance is indeed a separately payable service. Guidelines prior to spine code 62263 state, “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 77003, 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.” (Emphasis added by ASA.)

“Although injection of contrast is an inclusive component of the spinal injections listed, fluoroscopic guidance is not. The CPT text above clearly establishes that it is correct to report both the fluoroscopic guidance and the pain procedure when the procedure is done under fluoroscopy: Only the injection of contrast is bundled,” ASA states.

“It is therefore quite inconsistent with the CPT book and coding system to treat fluoroscopic guidance as an included component of the pain medicine procedures in question,” says the society. “While the code number has been changed since these instructions were issued, the instructions are still valid and are as relevant to code 77003 as they were to code 76005,” it says.