Yes, the flouro is thought to be very important. I've seen many (including doctors) who go so far as to suggest it's malpractice to do it without flouro.
The first pain doc I described had been doing injections since before flouroscopes were still made out of stone. He did the injections with me laying on my side on an exam table in his office. The billing for the ESI was an insignificant add-on to an office visit. He gently gets the needle where he wants it without flouro, I belive, with way better results than the average doc with flouro.
The doctor who caused all the pain with his less accurate technique in spite of using guidance needed to have me in a prodecure room (OR) with all the extra equipment. The ESI gets billed out as if it was surgery with facilities fees and a ton of extras. Instead of a $200 injection done as part of an office visit, it's a $3000 gotcha.
I agree flouro is better, but it doesn't make up for poor technique. Just like I'd rather have a good fusion than a poorly done ADR; a well done open discectomy than poorly done endoscopic procedure, etc... ; I'll take the old guy without flouro if he's that good. (unfortunately, as patients, we only find this by dumb luck. I don't think there is a good way to evaluate this in advance. "Are you good?" will not yield a useful reply.)
Mark
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