The decision by the AMA CPT Committee to bundle fluoroscopic guidance into certain pain procedure codes has significant implications for pain physicians and ambulatory surgery centers, says Frank J.E. Falco, MD, executive vice president of American Society of Interventional Pain Physicians and medical director of Mid-Atlantic Pain Institute in Newark, Del. Here Dr. Falco makes three points about the changes.
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1. Fluoroscopy now part of some procedure codes. In Jan. 2010, fluoroscopic guidance was bundled into paravertebral facet joint injections under codes 64490-64495. And in Jan. 2011, fluoroscopic guidance was bundled into transforaminal epidural codes 64479, 64480, 64483 and 64484. "The thinking is that fluoroscopy has become an integral part of these procedures and should be bundled with them," Dr. Falco says.
2. This means less income for the ASC. In both cases, the new CPT codes incorporating fluoroscopic guidance include an increase in the RVU, resulting in a modest increase in the physician's professional component, but there was no increase in the facility fee for the ASC. While the physician had a net loss of $20, the ASC lost $40-$50. "The ASC has to absorb the cost," Dr. Falco says. That means not being able to recoup the cost of a top-of-the-line c-arm for fluoroscopy guidance, priced at $70,000-$120,000.
3. More fluoroscopy bundling expected. Fluoroscopic guidance has not been bundled into other procedures such as spinal procedures with codes 62267, 62270-62282 and 62310-62319. But viewing the decisions so far, Dr. Falco believes more procedures will incorporate codes for fluoroscopic guidance.
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