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billing 77003 multiple units

jeannie1977

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The doctor we bill for is questioning if he can bill multiple units of 77003 to any commercial payers. We are aware of Medicare rules and MUE. Does anyone have any documentation that we would be able to present to him regarding this?

Thank you
 

dwaldman

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3. CPT codes 76942, 77002, 77003, 77012, and 77021 describe radiologic guidance for needle placement by different modalities. CMS payment policy allows one unit of service for any of these codes at a single patient encounter regardless of the number of needle placements performed. The unit of service for these codes is the patient encounter, not number of lesions, number of aspirations, number of biopsies, number of injections, or number of localizations

Above is the statement from the NCCI policy manual, below is from AMA CPT Assistant, which states the repeat reporting of 76005 (now 77003) would only be valid if there were 2 separate procedures that were performed in two separate spinal regions.

September 2004 page 1

The Facets of Paravertebral Facet Joint Procedures (64470-64476, 64622-64627)


Coding Tip

Code 76005 is intended to be reported per spinal region (eg, cervical, lumbar) and not per level.
 
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