US OR CT GUIDANCE?

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Which guidance code? 76942 is bundled into 77012. CT used for localization..US used for needle insertion...Does one always have to use the primary guidance code, or does documentation tell us which code to use?
PROCEDURE: The patient was placed in a RLD position on the table.
 CT imaging was performed to choose a site for insertion of the
needle. The L3/4 interspace was chosen, and the skin overlying
the space was marked.  The skin of the left flank was prepped and
draped in sterile fashion and local anesthesia using lidocaine
was infused at the insertion site.  Using fluoroscopic guidance a
22 gauge, 5" spinal needle was inserted into the thecal sac.
Clear CSF was easily obtained 1mls.  Specimens were collected and
sent to the laboratory for evaluation. 5mls of Spinar was
injected without difficulty over 2 minutes. The needle was
removed and the site was dressed with a Band aid.  There were no
complications in the patient left the IR suite in stable
condition.  
IMPRESSION

 Successful, uncomplicated lumbar puncture with fluoroscopic
guidance.
Permanent CT images were obtained and stored in the PACS system.​
 
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Coeur d'Alene, Idaho
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Good afternoon! I'm not seeing US documented within this report. I'm seeing CT and fluoroscopy. Fluoroscopy is a type of medical imaging that shows a continuous x-ray image on a monitor. As this is documented as using both CT and fluoroscopic guidance for needle placement, I would recommend querying the provider to determine if both modalities were indeed used for this procedure as only one may be reported in addition to the primary code for the diagnostic lumbar puncture.
 

luhre

Networker
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Syracuse, NY
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It looks to me that CT images were done but Fluoroscopic guidance was used to place the needle. I would code the Lumbar Puncture with Fluoroscopic guidance.
 
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Good afternoon! I'm not seeing US documented within this report. I'm seeing CT and fluoroscopy. Fluoroscopy is a type of medical imaging that shows a continuous x-ray image on a monitor. As this is documented as using both CT and fluoroscopic guidance for needle placement, I would recommend querying the provider to determine if both modalities were indeed used for this procedure as only one may be reported in addition to the primary code for the diagnostic lumbar puncture.
 
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Amanda....duh...so sorry...meant to say Fluoro and CT Guidance....oftentimes there is CT guidance in addition to US or Fluoro….my question is....must one use the primary code, or can we code the secondary guidance code, documentation permitting? If the CT is for localization of the area, and then the Fluoro was used for needle guidance, should I use the Fluoro code? I see that user Luhre is saying to use the guidance that was used for the actual needle placement. This is my thinking also....what do you think?
 
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Thanks so much, Amanda. I agree....this makes the most sense. And since the reports I code oftentimes have more than one type of guidance, this is very helpful.
 
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I think everything was done in the CT scanner so I would code for CT guidance. Modern scanners can perform fluoroscopy as well as scan.
Jim....so you would go with where the procedure was done...in this case, the CT scanner, as opposed to the guidance used for the needle placement.....correct?
 
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