Part B Insider (Multispecialty) Coding Alert

Published on Thu Sep 20, 2012 PDF

Avoid separately reporting 76000 or 77002.

Not all of the coding changes for next year involve new codes. You should pay close attention to code descriptor revisions as well. Of note, CPT® 2013 alters the wording for 64561. Take a look at the change to ensure you don't inaccurately report this neurostimulator code.

Leave 76000, 77002 Off Neurostimulator Claims

CPT® 2013 revises the descriptor of 64561 as follows: Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed. The new description adds the phrase "including image guidance, if performed."

That means you cannot report codes 76000 (Fluoroscopy [separate procedure], up to 1 hour physician time, other than 71023 or 71034 [eg, cardiac fluoroscopy]) or 77002 (Fluoroscopic guidance for needle placement [eg, biopsy, aspiration, injection, localization device]) with 64561, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, University Hospital, State University of New York, Stony Brook.

"As with a lot of codes now imaging is included," says Christy Shanley, CPC, department administrator for the University of California, Irvine department of urology. "Hopefully they have increased the RVUs a bit."

"In general I think that we may lose a little reimbursement by adding the guidance to be inclusive to 64561," says Chandra L Hines, practice supervisor of Wake Specialty Physicians in Raleigh, NC.

Good news: Your coding won't likely change due to this revision because the Correct Coding Initiative (CCI) already bundled 64561 with both 76000 and 77002. However, both bundles had a modifier indicator of "1," meaning you were allowed to break the bundles under certain clinical circumstances using modifier 59 (Distinct procedural service). Now you will never be able to report the two fluoroscopy codes with 64561.