If fluoro guidance was not used you can't use 49451 (or any of the other codes in this section) at all, with or without -52. When the code description lists a specific type of guidance, then that means that that guidance is not just included, but inherent in the procedure and to use that code you have to use that kind of guidance.
This case should have been coded with an unlisted code at best, or included in the physician's E & M service.
See CPT Assistant, July 2010.