Below is an example of Local coverage determination policy from WPS Medicare J5. If there is question whether the procedure utilized fluoroscopic image guidance. I would query the physician. If you are billing Medicare for this type of procedure you would want to look at the LCD for the Medicare carrier you are billing and review requirements and billing and coding guidelines. As seen below they state fluroscopic guidance must be utilized. Assisting the physician in educating him/her of the requirements of LCD or Medical policy of the carrier is very important and the policy can be updated so checking per month is necessary to make sure new requirements have not changed. Sometimes if you have questions about a procedure you are about to bill and you are going to post a question if you have the procedure note avaiable, you can copy and paste it. State here is the procedure note these are the codes I am thinking, Just confirming this is correct before releasing it. This way there is something suggest a point of view from the procedure note itself.
Below is the LCD stating fluoro is required
Therapeutic transforaminal epidural injections are appropriate for the following purposes:
Corticosteroid can be added as a therapeutic measure. Injections for therapeutic reasons can be of greater volume. The transforaminal injection can be performed for diagnostic, therapeutic or both purposes.
Radicular pain resistant to more conservative measures or when surgery is contraindicated.
Post-decompressive radiculitis or post surgical scarring
Monoradicular pain, confirmed by diagnostic block in which a surgically correctible lesion cannot be identified
Treatment of acute herpes zoster or post herpetic neuralgia
Fluoroscopic guidance must be utilized in the performance of single nerve root/transforaminal injections to ensure the precise placement of the needle and medications injected.
Here some info from CPT Assistant Feb 2011
The following codes were revised for 2011:
64479 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, single level
+64480Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional level (List separately in addition to code for primary procedure)
64483 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level
+64484Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional level (List separately in addition to code for primary procedure)
The transforaminal epidural injection codes64479-64484describe injections that enter the epidural space through the intervetebral foramen. This technique differs from interlaminar [translaminar] epidural injection technique (62310-62311) and the paravertebral facet joint nerveinjection technique (64490-64495). Since the vertebral artery (in the cervical spine), radiculomedullary arteries, as well as the spinal cord are in close proximity to the nerve root, this procedure involves a much higher risk with more work than a translaminar epidural injection.
Transforaminal epidural injectioncodes 64479, 64480, 64483, and 64484 now include the fluoroscopic and computed tomographic (CT) needle placement imaging services in the code descriptors. Imaging guidance (fluoroscopy or CT) and any injection of contrast are inclusive components of codes 64479-64484.
Consequently, the parenthetical instructions following code 77012,Computed tomography guidance for needle placement (eg biopsy, aspiration, injection, localization device), radiological supervision and interpretation, have been revised. This code is no longer reported in conjunction with the transforaminal epidural injection codes 64479-64484 and the paravertebral facet injection codes 64490-64495, as the imaging guidance is already included in these procedures.
Below is from
