Wiki Epidural Injections and Fluoro

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Tracey Thompson

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A client has supposedly received a letter from CMS stating that CMS will no longer pay for epidurals done without the use of fluoroscopic guidance. I am concerned of whether or not this is true. If anyone can give advice as to whether or not CMS does/will require the use of fluoroscopic guidance in order to bill for an epidural injection, please let me know ASAP.

I do know that there are instances such as RFA, where if fluoro is not used that the procedure is actually coded as a completely different procedure. Could this be the case with this as well?

Any help is greatly appreciated!!!
 
because it's becoming the standard for spinal procedures, more and more codes include fluoroscopic guidance each year. a prime example of this is 27096 for 2012. it includes fluoro now, as well as the arthrography that goes with it (I believe 73542, which was deleted?). the guidelines for 27096 also state that if it it is done without fluoro, to use 20552 instead. this is because it was deemed unsafe to perform this type of injection without guidance. I believe this same logic is being applied elsewhere in CPT (facet injections, transforaminal epidurals, etc.), so it wouldn't surprise me if that's why they're beginning to deny injections without fluoro. and yes in some cases you should use a completely different code, and that is typically detailed in the parenthetical notes along with each code. hope this helps!
 
I believe 62310 & 62311 also include fluoro when it comes to billing, but still needs to be done under fluoro. I would request a copy of the letter and verify what is being said.
 
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