Question 63047 and 77002

mandyh

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Can you bill 77002-26 for the use of fluoroscopic guidance when a Laminectomy 63047 is performed?
 

cpc2007

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There is an NCCI edit between 63047 and 77002. A modifier is allowed to bypass the edit, but when there is an edit, I typically go to the NCCI Policy Manual chapter that talks about the code I'm applying to see if there is a rule that can help. In this case, if we go to Chapter 8 for the 60000 codes, section C.20 says that "fluoroscopy reported as CPT 76000 shall not be reported with spinal procedures unless there is a specific CPT Manual instruction indicating that it is separately reportable." Guidelines also state "for some spinal procedures, there is a specific radiology guidance code that is reported in lieu of these fluoroscopy codes." So the NCCI Policy Manual points us back to the CPT manual to look for an instructional note under 63047 to see if fluoroscopy is billable. There is no such notation under 63047 or in the section of guidelines that precedes it. CPT 77002 is also an add on code. This means that we should check the CPT manual under 77002 to see if there is a defined list of codes that it may be billed with (not all add on codes have a set primary CPT code list but it's a good starting point to check). When I go to 77002 in CPT, the guidelines state to code 77002 with one of the following CPT codes:

(Use 77002 in conjunction with 10160, 20206, 20220, 20225, 20520, 20525, 20526, 20550, 20551, 20552, 20553, 20555, 20600, 20605, 20610, 20612, 20615, 21116, 21550, 23350, 24220, 25246, 27093, 27095, 27369, 27648, 32400, 32405, 32553, 36002, 38220, 38221, 38222, 38505, 38794, 41019, 42400, 42405, 47000, 47001, 48102, 49180, 49411, 50200, 50390, 51100, 51101, 51102, 55700, 55876, 60100, 62268, 62269, 64505, 64600, 64605)

CPT 63047 is not on that list. Therefore, since NCCI says fluoroscopy is included in all spinal procedures (which would include 63047) unless CPT says you can bill it separately, CPT guidelines for 63047 do not say to code fluoro separately, and 63047 is not a valid primary CPT for 77002, you cannot report 77002 with 63047 when the fluoroscopy is for the laminectomy. The only time you could unbundle 77002 with modifier 59 is if another code from the list above that may be billed with 77002 happened to occur during the same surgery as the work described by 63047 (which is why NCCI allows for the modifier to bypass the edit). I hope that helps!

Kim
www.codingmastery.com
 
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