Wiki Facet injections with both fluoroscopy and ultrasound

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NFBarner

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I think I need an opinion on this please! I have a lumbar facet injection procedure note where the doctor used both fluoroscopy and ultrasound. I know you would use the 0216T when just ultrasound was used, but when both are used, I am leaning towards 64493 as it includes fluoroscopy and not billing the ultrasound as it is bundled.
Any help would be greatly appreciated!
 
I would definitely code 64493 as 0216T is included in 64493 per NCCI. However the Cat III codes are not issued for purpose of reimbursement, but for data collection. I would consider doing a little research to determine if the 0216T can or should be reported also (with a -GZ modifier). If I didn't get a definitive answer quickly, just bill 64493.

On the other hand, if the ultrasound was used at a different lumbar level, certainly you should report the 0216T with the XS modifier.
 
The problem I see with 0216T XS for a separate level where ultrasound was used but not fluoroscopy in conjunction with a level performed with fluoroscopy 64493.

Is now the carrier has to paid two primary codes.

I would be reviewing what the purpose that was documented in the medical record of use two imaging guidance modalities.
 
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