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Radiology Coding Alert

5 Easy Steps to Reimbursement for Spinal Fluoroscopic Guidance

According to CMS, interventional and diagnostic radiologists reported the fluoro-scopic guidance code 76005 more than 50,000 times in 2001. Despite the code's popularity, however, many practices have difficulty collecting payment for their fluoro-scopic guidance services when performed with epidural injections. The following five steps can help your practice collect appropriate fluoroscopy reimbursement. Several subscribers report that their carriers deny fluoroscopic guidance (76005, 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) and bundle it into the following epidural injection codes:

62310 - Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic

62311 - ... lumbar, sacral (caudal).   The National Correct Coding Initiative ( CCI Edits ) does not include any edits barring practices from reporting the fluoroscopic guidance and epidural injection codes together, so you should inspect your claim to ensure that you submitted it correctly. And if you did, you should appeal the denial. Step 1: Confirm Your Guidance Code. Although 76005 is the appropriate fluoroscopic guidance code to submit with epidural injection claims, some coders still report 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) instead.

"CPT Codes 2000 introduced 76005 as the new code for fluoroscopy with spinal injections, leaving 76000 for use in conjunction with other services," says Julie Jarvis, owner of Underwood Billing, a coding and billing consulting firm in Orlando, Fla. "Unfortunately, some practices are following old advice and are still reporting 76000 with 62310 and 62311."

Radiology coders who are new to epidural injection billing might refer to outdated LMRPs or back issues of CPT Assistant to support billing 76000 with their epidural claims. The December 1998 CPT Assistant, for example, advised practices to report 76000 with epidural injections. More recent issues of the publication have updated this advice to reflect the more accurate code 76005, but some coders don't realize that and are still following the obsolete advice. Step 2: Confirm Your Carrier's Guidelines. Even if you submit your claim with the appropriate fluoroscopic guidance code (76005), your carrier may think you've used the incorrect fluoroscopy code. "Believe it or not, there are still insurers out there that haven't updated their systems since 2000," Jarvis says. Also, "it's not that unusual for workers' compensation or other private insurers to still [...]

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