Wiki 64520

[giardina44]

I am getting denied for the fluro guidance 77003 when i bill it with 64520. Is this bundled? The CPT book does not say that it is.. BUT the encoder we use is giving me that error.

Anyone have any insight of this?

Thanks for any help!

 

[dsheets07]

Fluoroscopy is allowed with this code, it will however require a modifier -59 to indicate that it was medically necessary and a separate component of the original procedure.

 

[dwaldman]

77003 is bundled and not separately reported with 64520 per NCCI. It is similar for example 64400, 64405, 64450, 64418, 64517, 64530, the list goes on for both 77002 and 77003 being bundled, CMS thru NCCI edits decided to bundled the use of fluoroscopic guidance with 64520 and many other codes. Under no circumstances would you it be compliant to add the 59 modifier when the fluoroscopic guidance was utilized to execute only column one injection code that they find fluoroscopic guidance bundled as column two code.

The National Correct Coding Imitative Policy Manual for Medicare Services, Chapter 1, Section E (Modifiers and Modifier Indicators) states:

"NCCI edits define when two procedure HCHPCS/CPT codes may not be reported together except under special circumstances. If an edit allows use of NCCI-associated modifiers, the two procedure codes may be reported together when the two procedures are performed at different anatomic sites or different patient encounters. Carrier (A/B MAC processing practitioner service claims) procession systems utilize NCCI-associated modifiers should NOT be used to bypass an NCCI edit unless the proper criteria for use of the modifier are met"