Can I Bill for Fluoroscopy?

Question:

I did a left intraarticular steroid injection in the ASC. I used fluoroscopic guidance. Can I report the Fluoro separately or is it included in the procedure code I used 20610?

Answer:

Yes, you can report fluoroscopic guidance with CPT code 20610. In the ASC make sure you report 77002-26. Modifier 26 is required when you perform guidance in the hospital or ASC when the equipment is owned by the facility.

*This response is based on the best information available as of 01/21/21.

Sphenopalatine Ganglion Block

Question:

I cannot find a CPT code to report using a device to deliver medication through the nose when a sphenopalatine ganglion block is performed under fluoroscopic guidance for patients with migraine headaches. Can you provide me with the correct CPT code?

Answer:

There is no specific CPT code that accurately describes this service. The code set includes code 64505, which describes the injection of the sphenopalatine ganglion. However, it is inappropriate to  report this code since an injection is not performed. Therefore, the unlisted code 64999, Unlisted procedure, nervous system, should be reported.

*This response is based on the best information available as of 08/06/20.

Blood Patch with Epidural

Question:

My anesthesiologist had to perform a blood patch on a patient who received an epidural the day before. Can we bill for this?

Answer:

It depends. If the patch was performed through the same catheter for the epidural, then this would not be separately billable. However, if the blood patch was performed as a new injection into the epidural space, then it would be separately billable with CPT 62273.

*This response is based on the best information available as of 06/25/20.

Genicular Nerve RFA

Question:

I’m new to coding. What code would I use for radiofrequency ablation of the genicular nerve?

Answer:

You’re in luck! There is a new code in 2020: 64624 Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed. The code includes destruction (e.g., chemical means, radiofrequency ablation) of all branches of the genicular nerve including the the superolateral, superomedial, and inferomedial genicular nerves. CPT 64624 also includes fluoroscopic/imaging guidance so you would not report a separate radiology code (7xxxx).

*This response is based on the best information available as of 05/29/20.

Fluoroscopic Guidance and Trigger Point Injections

Question:

I would like to know if generally speaking if Medicare pays for trigger point injection CPT code 20552 with imaging guidance? If yes I would like to know if I can use fluoroscopy or it has to be ultrasound.

Answer:

Medicare as well as other payors should pay for fluoroscopy guidance separately unless they have a medical policy that differs from CPT Trigger point injections do not include imaging guidance and can be reported separately.From CPT Assistant: “The trigger point injection(s) codes (20552 and 20553) are reported once per session based on the number of muscles injected, regardless of the number of trigger points injected in each muscle. Code 20552 is reported for trigger point(s) injection(s) in 1 or 2 muscles, and code 20553 is reported for trigger points injection(s) in 3 or more muscles. If imaging guidance is utilized, report the appropriate radiology code (76942,77002, and 77021) in addition to the injection codes.”

*This response is based on the best information available as of 02/06/20.

Trigger Point Injections Coding: Muscle or Muscle Group

Question:

One of our Providers recently completed Trigger Point injections toBilateralThoracic ParaspinalsandBilateralTrapeziusin the same setting for a patient. When we bill for this procedure do we counteachside(Left and Right) of these procedures as a muscle group to be billed out as 20553 OReacharea(Bilateral or unilateral) of these procedures as a muscle group to be billed out as 20552?

Answer:

Trigger points are by muscle(s) injected; 20552 is 1-2 muscles, 20553 is more than 3 or more muscles.  He injected 4 muscles (2 paraspinal and 2 trapezius) so the code billed is 20553. Additionally, these codes are not reported bilaterally with a 50 modifier or with an RT/LT. Report by the number ofmusclesinjected.

*This response is based on the best information available as of 12/19/19.