64640 and 77003

jeannie1977

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Can fluoro be billed when doing 64640? Doc usually does 64635 and 64640 and wants to bill 77003.

Thanks for your help!
 

dwaldman

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64640 and 77003 are not bundled per NCCI. I have not seen the AMA address if there is a procedure that requires and includes fluoro and procedure that does not, if performed in the same spinal region or in a close anatomical location if they consider that it is separately reportable. I think if I was going to take the side that it shouldn't be reported I would get a response from the AMA CPT Network on the question before I would tell the physician that it is not reportable based on coding conservatively or not sure.
 
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Go to CMS medicare website. column medicare, NCCI edits, PTP EDits, add-on codes- this will show you secondary/add-on codes that are allowed with the primary codes 64640 and 77003 are not allowed per this information. Hope this helps. I tried to copy chart (didn't allow) - if you need it email me at claudine@premiercaremedicalcenter.com and I will email it to you.
 

dwaldman

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Claudine,

I don't show 64640 & 77003 has NCCI edit as of 06/13/19 that prevent the reporting the two procedures together, but that doesn't mean CPT 77003 is the correct code to report with 64640 in all or any circumstances because there is not alot information on the AMA's current guidance on it. When looking at the AMA CPT manual, they don't currently suggest to "use in conjunction" a primary procedure of 64640 with either 77002 or 77003. But it is technically not an all inclusive list, like a mandatory primary procedure required because for example it is allowed to report 62370 and 77002 together but 62370 is not listed as "in conjunction" procedure for 77002.
 
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@dwaldman - As I stated earlier - I pulled the Medicare CMS.GOV/PTPEDIT/ADD-ONEDIT; This shows what they allow- I actually had to use this 2 years ago to get highmark to pay 20610 and 77002 - as it shows the latter two can be billed together. You are correct that it is not in NCCI- but NCCI , though thorough, does not have everything in it- wish it did!! I have found 1 or 2 occupational insurance companies that pay 77003 with 64640
 

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