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Fluoroscopic guidance is a critical imaging technique utilized in various medical procedures, particularly for spinal or paraspinous diagnostic and therapeutic injections. This method involves the use of continuous X-ray technology, which allows healthcare professionals to visualize the internal structures of the body in real-time. By projecting the X-ray images onto a monitor, physicians can effectively track the movement and positioning of instruments such as needles or catheters during the procedure. The primary goal of using fluoroscopic guidance is to accurately locate the target site for the injection, ensuring that the needle or catheter tip is precisely positioned for optimal therapeutic effect. This technique is particularly important in procedures involving the epidural or subarachnoid spaces, where accurate placement is essential for the successful delivery of medications such as anesthetics or steroids. The process typically involves the injection of a small amount of contrast material, which enhances the visibility of the target area under fluoroscopy, allowing for real-time monitoring and adjustments as necessary. The use of fluoroscopic guidance not only improves the accuracy of the injection but also enhances patient safety by minimizing the risk of complications associated with misplacement. Following the procedure, a detailed written report is generated, documenting the radiological aspects of the intervention, which is essential for medical records and further patient management.
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Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures are indicated for various conditions and symptoms that require precise intervention. The following are the explicitly provided indications for this procedure:
The procedure for fluoroscopic guidance and localization of needle or catheter tip involves several critical steps to ensure accuracy and safety. Each step is detailed as follows:
After the fluoroscopic guidance and injection procedure, patients are typically monitored for a short period to assess for any immediate adverse reactions or complications. It is common for patients to experience some discomfort at the injection site, which may be managed with ice or over-the-counter pain relief. Instructions regarding activity restrictions, follow-up appointments, and signs of potential complications, such as increased pain or signs of infection, are provided to the patient. The physician may also schedule follow-up visits to evaluate the effectiveness of the injection and determine if additional treatments are necessary.
| Short Descr | FLUOROGUIDE FOR SPINE INJECT | Medium Descr | FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON | Long Descr | Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 4 - Diagnostic Radiology | Berenson-Eggers TOS (BETOS) | I4B - Imaging/procedure - other | MUE | 1 | CCS Clinical Classification | 226 - Other diagnostic radiology and related techniques |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 61050 | MPFS Status: Active Code APC T ASC A2 CPT Assistant Article Cisternal or lateral cervical (C1-C2) puncture; without injection (separate procedure) | 61055 | MPFS Status: Active Code APC T ASC A2 CPT Assistant Article Cisternal or lateral cervical (C1-C2) puncture; with injection of medication or other substance for diagnosis or treatment | 62267 | MPFS Status: Active Code APC T ASC G2 CPT Assistant Article Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or paravertebral tissue for diagnostic purposes | 62273 | MPFS Status: Active Code APC T ASC A2 CPT Assistant Article Illustration for Code Injection, epidural, of blood or clot patch | 62280 | MPFS Status: Active Code APC T ASC A2 Physician Quality Reporting CPT Assistant Article Illustration for Code Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; subarachnoid | 62281 | MPFS Status: Active Code APC T ASC A2 Physician Quality Reporting CPT Assistant Article Illustration for Code Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, cervical or thoracic | 62282 | MPFS Status: Active Code APC T ASC A2 Physician Quality Reporting CPT Assistant Article Illustration for Code Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, lumbar, sacral (caudal) | 62284 | MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Illustration for Code Injection procedure for myelography and/or computed tomography, lumbar | 64449 | MPFS Status: Active Code APC T ASC G2 Injection(s), anesthetic agent(s) and/or steroid; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement) | 64510 | MPFS Status: Active Code APC T ASC A2 Physician Quality Reporting Illustration for Code Injection, anesthetic agent; stellate ganglion (cervical sympathetic) | 64517 | MPFS Status: Active Code APC T ASC A2 CPT Assistant Article Injection, anesthetic agent; superior hypogastric plexus | 64520 | MPFS Status: Active Code APC T ASC A2 Physician Quality Reporting Illustration for Code Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic) | 64610 | MPFS Status: Active Code APC J1 ASC A2 Physician Quality Reporting CPT Assistant Article Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale under radiologic monitoring | 96450 | MPFS Status: Active Code APC S Physician Quality Reporting PUB 100 CPT Assistant Article Chemotherapy administration, into CNS (eg, intrathecal), requiring and including spinal puncture |
| 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | TC | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | GC | This service has been performed in part by a resident under the direction of a teaching physician | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | PC | Wrong surgery or other invasive procedure on patient | GA | Waiver of liability statement issued as required by payer policy, individual case | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | RT | Right side (used to identify procedures performed on the right side of the body) | LT | Left side (used to identify procedures performed on the left side of the body) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | X2 | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services | MH | Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider | 27 | Multiple outpatient hospital e/m encounters on the same date: for hospital outpatient reporting purposes, utilization of hospital resources related to separate and distinct e/m encounters performed in multiple outpatient hospital settings on the same date may be reported by adding modifier 27 to each appropriate level outpatient and/or emergency department e/m code(s). this modifier provides a means of reporting circumstances involving evaluation and management services provided by physician(s) in more than one (multiple) outpatient hospital setting(s) (eg, hospital emergency department, clinic). note: this modifier is not to be used for physician reporting of multiple e/m services performed by the same physician on the same date. for physician reporting of all outpatient evaluation and management services provided by the same physician on the same date and performed in multiple outpatient setting(s) (eg, hospital emergency department, clinic), see evaluation and management, emergency department, or preventive medicine services codes. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 74 | Discontinued out-patient hospital/ambulatory surgery center (asc) procedure after administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc). under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of modifier 74. note: the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. for physician reporting of a discontinued procedure, see modifier 53. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 92 | Alternative laboratory platform testing: when laboratory testing is being performed using a kit or transportable instrument that wholly or in part consists of a single use, disposable analytical chamber, the service may be identified by adding modifier 92 to the usual laboratory procedure code (hiv testing 86701-86703, and 87389). the test does not require permanent dedicated space, hence by its design may be hand carried or transported to the vicinity of the patient for immediate testing at that site, although location of the testing is not in itself determinative of the use of this modifier. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | ET | Emergency services | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | KX | Requirements specified in the medical policy have been met | MG | The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | SG | Ambulatory surgical center (asc) facility service | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
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Action
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Notes
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| 2021-01-01 | Note | Guidelines changed. |
| 2017-01-01 | Changed | Long and Medium descriptions changed. Guidelines changed. |
| 2013-01-01 | Changed | Guideline information changed. |
| 2012-01-01 | Changed | Description Changed |
| 2011-01-01 | Changed | Long description revised. Guideline information changed. |
| 2010-01-01 | Changed | Code description changed. |
| 2007-01-01 | Added | First appearance in code book in 2007. |
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