ALERT: FLUOROSCOPIC GUIDANCE NO LONGER BUNDLED WITH SPINAL INJECTIONS

Fluoroscopic guidance and localization (CPTT code 76005) should once again be separately payable when performed together with certain spinal injection procedures.

McKesson Information Solutions, the company that provides code-bundling software to private health plans including many of the Blue Cross and Blue Shield licensees, has advised us that it is discontinuing the "edits" that bundle codes 76005 with 62270-62273, 62280-62282, 62310-62319, 027T, 64470-64476, 64479-64484 and 64622-64627. This means that payers will not be able to point at McKesson any longer but will have to decide for themselves whether to take action to continue an indefensible policy of denying claims for fluoro.

The changes in McKesson's "auditing logic" result from correspondence between Alexander A. Hannenberg, MD, ASA Vice-President for Professional Affairs, and McKesson, as well as from the ASA memorandum on the inappropriateness of bundling fluoroscopy http://www.asahq.org/news/fluoroscopy120403.pdf and communications from anesthesiologists and pain medicine specialists to their third-party payers.

Payers will not necessarily change the way in which they process claims for code 6005 immediately. In an email message to Dr. Hannenberg dated April 23, 2004, the Medical Director for the McKesson Clinical Auditing & Compliance Division wrote:

We are currently communicating with our clients about the scope of these changes; however, becaus

e our knowledge base updates occur only once or twice/year (depending on the product), the proposed McKesson changes will not occur immediately unless individual health plans customize their currently installed knowledge base releases. 

The changes we have proposed to clients are closely aligned to the 2004 CPT guidance for 76005 and the spinal injection codes, with and without imaging. Because our software is fully customizable for the affected codes, the final editing determinations will ultimately be made by each healthplan, regardless of our default editing configuration or when that might become generally released.  In other words, healthplans using our software can implement the proposed changes now or develop their own medical coverage policies for preserving these edits indefinitely. 

My advice for the ASA membership is to resume their discussions with each of the healthplans with which they participate to get an update on 76005 and request a rationale for any edits that are preserved of those identified by ASA as targeted codes.

Anesthesiologists and their billing staff who have had claims for fluoroscopic guidance and localization denied should contact their payers -- at least the payers who base the denials on the McKesson software -- and discuss the situation in light of the McKesson changes.

Thank you to the many practices that kept the drumroll going!