because it's becoming the standard for spinal procedures, more and more codes include fluoroscopic guidance each year. a prime example of this is 27096 for 2012. it includes fluoro now, as well as the arthrography that goes with it (I believe 73542, which was deleted?). the guidelines for 27096 also state that if it it is done without fluoro, to use 20552 instead. this is because it was deemed unsafe to perform this type of injection without guidance. I believe this same logic is being applied elsewhere in CPT (facet injections, transforaminal epidurals, etc.), so it wouldn't surprise me if that's why they're beginning to deny injections without fluoro. and yes in some cases you should use a completely different code, and that is typically detailed in the parenthetical notes along with each code. hope this helps!
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