77003 and Epidurals

[jflynn]

Does anyone have anything in black and white about billing CPT 77003 and CPT's 62310/62311? We have billed this combination forever and have always been paid until recently. The information we are finding is conflicting on to bill or not to bill. Any help is appreciated.

 

[mhstrauss]

Does anyone have anything in black and white about billing CPT 77003 and CPT's 62310/62311? We have billed this combination forever and have always been paid until recently. The information we are finding is conflicting on to bill or not to bill. Any help is appreciated.

Yes, just another example of Medicare guidance conflicting with AMA/CPT guidelines!!

For AMA reference, see the section heading "Spine and Spinal Cord--Injection, Drainage, Aspiration". There is direction there to use 77003 for fluoro for numerous codes, including 62310/62311--with exceptions, but for a typical ESI, 77003 IS separately billable.

CMS stopped paying on 77003 when billed with 62310/62311 effective 1-1-15, per changes to NCCI edits, as part of the PFS Final Rule.

Any payers that follow Medicare guidelines for CCI likely won't pay for it.

More info about CMS's decision in this older thread:

https://www.aapc.com/memberarea/forums/110547-77003-62310-62319-proposed-rule-2015-a.html

 

[Simone88]

Usg

62310 and 62311 will not receive payment for 77003 fluoroscopic guidance. Still, Medicare wants you to list the code with BU at the end. It will not be paid but they can see that it was used. This has been since early last year. I code for LESI and CESI but must show that this service is BUndled with the injection. Not sure why but that is how they roll.

 

[mhstrauss]

62310 and 62311 will not receive payment for 77003 fluoroscopic guidance. Still, Medicare wants you to list the code with BU at the end. It will not be paid but they can see that it was used. This has been since early last year. I code for LESI and CESI but must show that this service is BUndled with the injection. Not sure why but that is how they roll.

Where did you get this info regarding modifier BU? From what I'm seeing, this is for DME rentals.

 

[L4uniki]

Does anyone have anything in black and white about billing CPT 77003 and CPT's 62310/62311? We have billed this combination forever and have always been paid until recently. The information we are finding is conflicting on to bill or not to bill. Any help is appreciated.

It appears 77003 is being bundled as the code descript for 62310 and 62311 instruct "includes contrast for localization when performed."

 

[mhstrauss]

It appears 77003 is being bundled as the code descript for 62310 and 62311 instruct "includes contrast for localization when performed."

77003 for fluoro guidance IS NOT the contrast for localization. These are separate issues. Per CPT coding, fluoro guidance is not included in 62310/62311.

 

[kmgauthier]

Per CPT guidelines fluoroscopy should be reported. Typically these will get paid with a 59 modifier on the 77003. It can also be helpful to submit a copy of the CPT book highlighting the information stating that the fluoro is not included in 62310/62311, if it still rejects.

Krystal Gauthier, CCS-P

 

[CodingKing]

It can also be helpful to submit a copy of the CPT book highlighting the information stating that the fluoro is not included in 62310/62311, if it still rejects.

I'd say its a waste of time. Any payer can decide not to accept AMA's guidelines. Its extremely common occurrence with Medicare (look how many G codes they have created). They know what the CPT book says.

 

[marvelh]

For Medicare and any payer that uses the NCCI bundling edits to process claims, do NOT append modifier 59 to the 77003 code when performed with the 62310 - 62319 codes. Modifier 59 would ONLY be appended if the fluoroscopy was used with a DISTINCT, i.e. different, procedure. If the fluoroscopy is used just for the epidural injection, then it would NOT be compliant to add modifier 59 just to get it paid. There are RAC and ZPIC audits on the use of this modifier to bypass the Medicare NCCI bundling edits. Purposely adding a modifier just to get paid has been determined to be fraudulent by some Medicare auditors. The penalties for fraud are substantial as well as the Pandora's box that it opens!