Wiki 77003 and 62311/62310

[jeashore]

77003 and Epidural Steroid Injections

Can fluoroscopy be billed with epidural injections- 62311 and 62310? I bill for an ASC and BCBS is notifying us that 77003 and 62311 can't be billed together, that fluoroscopy is included in the procedure code. I know contrast dye can't be billed separately, but not understanding why we are being told fluoroscopy is included in these 2 epidural codes when the description does not state with or including imaging guidance. Any input would be great! Thank you.

 

[kivbar16]

You can bill fluoroscopy separately, it will need the 59 modifier. It is not included in the 62311/62310. You can only report it once per day.

 

[jeashore]

Thank you!

 

[AshleyCRPM]

Did you have any luck with this? We are billing for 62311 with 77003 and a 59 mod but the 77003 is still getting kicked back. Ive never had this problem before...

 

[CodingKing]

Looks like NCCI is overriding AMA guidelines on this. The following was added to the NCCI manual for 2016

21. CPT codes 62310-62319 describe injections of diagnostic or therapeutic substance(s) into the epidural or subarachnoid spaces at different spinal levels. Fluoroscopic guidance such as CPT code 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid))is included in these procedures and should not be reported separately with these codes.

 

[jeashore]

Looks like NCCI is overriding AMA guidelines on this. The following was added to the NCCI manual for 2016

The claim rejections are from 2015. Should I append modifier 59 to 77003 then? I haven't tried billing with the modifier because we were waiting for the appeal process to be completed. Our appeal has been denied by BCBS and they are still insisting 77003 is included in the primary procedure payment (62310 and 62311) and can't be billed separately. Please advise. Thank you.