Can I bill 77003 with 62310 & 62311?

[debtaube]

Can I bill for the fluoro (77003) with 62310 & 62311. I am finding conflicting info. Medicare and BCBS are currently paying our claims but many other commercial companies say 77003 is bundled with 62310 & 62311.
Thanks.

 

[cklein]

I am not able to get BCBS to pay for 77003. I thought 77003 was included within those codes. I was going to try a 59 modifier but I am getting conflicting info as well. Someone please give me some guidance.
thanks

 

[Pmentzer]

There is a CCI edit showing that 77003 is now included in the 62310 and 62311

 

[luhre]

Coding Data Analyst, CPC

Many codes are listed under CPT 77003 as "included in" and "do not report in conjunction with".

 

[mitchellde]

The codes listed under 77003 as included are the injection codes, the 77003 is the flouro guidance code FOR the injection procedure and the contrast is the inclusive part. The payer is incorrectly bundling it together due to a bad edit which is probably due to misunderstanding. There is no reason at all for there to be a CCI edit for these procedures, however that U.S. a hard issue to fight. It will be like swimming upstream!

 

[dwaldman]

"After considering comments received, we are finalizing CPT codes 62310, 62311, 62318, and 62319 as potentially misvalued, finalizing the proposed RVUs for these services, and prohibiting separate billing of image guidance in conjunction with these services."

https://www.federalregister.gov/arti...cal-laboratory

Above is from the final rule from 2015 for physician fee schedule for Medicare which states they prohibit separate billing of image guidance with epidural codes 62310-62319. It wasn't until April 1st that NCCI placed 77003 as column 2 code to the epidurals. The purpose of this edit was based on the fact that they voiced in the 2015 final rule that separate billing of fluoro was not reportable. The edit was backdated to 01/01/2015, which means CPT 77003 was bundled for Medicare since January 2015 when image guidance utilized & performed with the epidural codes. Medicaid, who also follows NCCI, has this edit and it would be inappropriate to bill Medicaid 77003 with 62310-62319. Plans such as Care Improvement Plus or other Medicare Advantage plans would follow Medicare guidelines.
From a AMA perspective in 2015, 77003 was still recognize as appropriately reported with the interlaminar/caudal epidural codes. The fact that Medicare has identify the codes as misvalued and brings in question if the AMA will include fluoroscopy in the code descriptor for 2016. For carriers that still recognize the separate billing of 77003 that are non-Medicare/non-NCCI based on their payment methodlogy it would be compliant to report 77003 if they have not already adopted an edit that mimics CMS/NCCI.