Wiki ESI and Fluoro reporting

[nan.coder]

We are receiving Workcomp denials that FLuoro code 77003 is included in value of other services. Upon appeal, the reply is to see 11/13/14 Federal Register, pages 65,779.

Does anyone have definitive information that CPT 77003 can be billed and paid separately from CPT 62310 and 62311 for Workcomp and commercial carriers?

ASCExpert shows that 77003 had an N1 ASC payment indicator and also shows that the code can be reported in an ASC with 62310 and 62311 with only a -tc mofidier.

thank you.

 

[marvelh]

Per the 2015 Medicare Physician Fee Schedule that was published in the November 2014 Federal Register:

After considering comments received, we are finalizing CPT codes 62310, 62311, 62318, and 62319 as potentially misvalued, finalizing the proposed RVUs for these services, and prohibiting separate billing of image guidance in conjunction with these services.​

Here is the link to the Nov Federal Register:
http://www.cms.gov/Medicare/Medicar...ral-Regulation-Notices-Items/CMS-1612-FC.html Click on the link for CMS-1612-FC at the bottom of the page. In the PDF the section 'Epidural Injection and Fluoroscopic Guidance?CPT Codes 62310, 62311, 62318, 62319, 77001, 77002 and 77003" starts on page 67578 with the final decision on the following page.

It is possible that this state's workers compensation is based on Medicare and as such has adopted Medicare's inclusion of image guidance with the 62310-62319 code set.

 

[KMCFADYEN]

CMS did change their payment for ESI's as of 1/1/15. they consider the fluoro (77003) to be an integral part of the ESI. As for work comp, they should not be basing on CMS as AMA still allows for seoarate billing. I would appeal.