Below is in 2008 they describe reporting 77002 with 64640, but then in later CPT Assistant they describe reporting 77003 with 64520 which would not be the same guidance as seen with 2008 article. They later revisited this article in 2010 and describe which codes they suggest can be reported with 77003. There is not NCCI code bundling edit with 64640 with either 77002 or 77003. But other private payers might find it inclusive per the bundling edits. You could submit the question to the AMA CPT Network, describing the procedure that is performed for 64640 and what fluoroscopic guidance code they feel is separately reportable.
AMA CPT Assistant 2008
To differentiate, code 77002 rather than code 77003 should be reported to identify the fluoroscopic guidance performed in conjunction with injection codes 64400- 64450, 64505-64530, 64600-64620, or 64630-64680, because this code more accurately describes the fluoroscopic guidance procedure performed for the anatomy involved. (ie, these types of injections are not included in the list in the 77003 code descriptor).
AMA CPT Assistant 2010
Code 77003 identifies the fluoroscopic guidance to assist in accurately localizing specific spinal anatomy for placement of a needle, catheter tip for spine or paraspinous diagnostic, or therapeutic injection procedures (epidural, subarachnoid, or sacroiliac joint) including neurolytic agent destruction. Therefore, code 77003 is reported in conjunction with codes 62267, 62270-62273, 62280- 62282, and 62310-62319, when fluoroscopic guidance is necessary and performed with these injection, drainage, or aspiration procedures.
Below addresses your question regarding 77003 being inclusive to 72295 per the AMA.
AMA CPT Assistant 2008
Fluoroscopy is also considered inherent to many radiological supervision and interpretation (RS&I) services, such as those provided in support of gastrointestinal examinations, arthrography, myelography, cholecystography, venography, arteriography, and cystography
AMA CPT Assistant March 2011 page 7
Coding Communication:Injection Procedure for Discography, Lumbar
Question: What is the proper use of codes 62290, 72285, and 72295 when reporting lumbar discography procedures? When should code 77003 (fluoroscopic guidance) be reported with the discography procedure?
Answer: To respond to your query, it is key to understand that dye injected into the disc space for tissue identification purposes is considered inclusive of the discectomy procedure performed (eg, 63030) and does not constitute diagnostic discography (62290). When performed for diagnostic purposes, independent of a discectomy, lumbar discography is essentially a two-part procedure. The first component is the placement of the needle into the disc with subsequent injection of contrast. The second component is the visualization of the dye pattern, the interpretation of the disc morphology, and often the interpretation of the pain response. When performing lumbar discography, code 62290, Injection procedure for discography, each level; lumbar, is the appropriate code to report for the injection procedure for each lumbar level. For cervical or thoracic discography, the appropriate injection code is 62291, Injection procedure for discography, each level; cervical or thoracic. Injection of contrast and localization during the imaging guidance portion (fluoroscopy) is an inclusive component of these injection procedures, and 77003 is not reported separately.
The radiological supervision and interpretation of lumbar discography is a separately reported service, as a radiologist may perform these services independently from the physician performing the injection procedure. The codes to report these services are code 72295, Discography, lumbar, radiological supervision and interpretation, for the lumbar region and code 72285, Discography, cervical or thoracic, radiological supervision and interpretation, for cervical or thoracic regions.
Because lumbar discography is reported per lumbar level, code 62290 may be reported multiple times during the same session on the same day, depending on the number of levels of lumbar discography performed. Typically, a modifier (eg, modifier 51) is attached to additional levels in order to avoid duplicating the pre- and postservice components of the work value. Similarly, the supervision and interpretation of the contrast material in the disc is dependent on the total number of discs injected. Therefore, typical coding for a three-level lumbar discography is as follows:
62290
62290-51 x 2 (three levels)
72295
72295-51 x 2 (three levels)
