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Fluoroscopic Guidance in Pain Management
By Penny Sparks, CPC
Billing fluoroscopic guidance in pain management can be confusing for billing staff. Fluoroscopy is an X-ray procedure used for localization of needle placement and to visualize the patient's anatomy.
To confirm needle placement, the fluoroscope is used as a guidance tool for needle placement. The biller should use 77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve, or sacroiliac joint), including neurolytic agent destruction for most of the common nerve block procedures such as paravertebral facet joint nerve or sacroiliac joint, epidural, transforaminal epidural, paravertebral facet joint, subarachnoid and including neurolytic agent destruction. Note: According to the CPTÂ®, code 77003 is per spinal region (cervical, thoracic, lumbar, or sacral). Do not bill per level. Modifier 59 Distinct procedural service can be used to identify a separate guidance/localization procedure performed in different spinal regions.
Use 77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) for fluoroscopic guidance for needle placement for non-spinal procedures. An example would be when a physician performs a major joint injection for a shoulder, knee or hip.
Use 76000 Fluoroscopy (separate procedure), up to one hour physician time, other than 71023 and 71034 (eg, cardiac fluoroscopy) and 76001 Fluoroscopy, physician time more than one hour, assisting a non-radiologic physician (eg, nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy) when the physician uses fluoroscope to provide diagnostic images.
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