Pain management

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Erie, PA
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I am having a discussion with my physician and how he wants to bill fluoroscopy. I have read the NCCI edits and medical policy...unfortunately, depending on what you read....there is much open to interpretation. If my physician were to code a 62311 or a 64418- is fluoroscopy included? He has a c-arm in the office and wants to add a 59 to pay for the fluoroscopy where in the medical policy states in a vague manner that this is included. He is doing these procedures for pain management. My understanding is that unless it is an entirely different location, he cannot surpass a straight (for example)epidural- (for radiating pain) or peripheral nerve block and add 77003 or 77002 as additional codes- are they not inclusive of the above mentioned codes? He thinks because there is an allowable edit that it is ok to add the fluoroscopy. I really need a direct response . Thank you!!!!
 

Walker22

True Blue
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Cumming, GA
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I am having a discussion with my physician and how he wants to bill fluoroscopy. I have read the NCCI edits and medical policy...unfortunately, depending on what you read....there is much open to interpretation. If my physician were to code a 62311 or a 64418- is fluoroscopy included? He has a c-arm in the office and wants to add a 59 to pay for the fluoroscopy where in the medical policy states in a vague manner that this is included. He is doing these procedures for pain management. My understanding is that unless it is an entirely different location, he cannot surpass a straight (for example)epidural- (for radiating pain) or peripheral nerve block and add 77003 or 77002 as additional codes- are they not inclusive of the above mentioned codes? He thinks because there is an allowable edit that it is ok to add the fluoroscopy. I really need a direct response . Thank you!!!!

If the code specifically states that imaging is included, then you cannot bill it separately.
 
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Erie, PA
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additional clarification

These codes do not state that they include fluoroscopy though NCCI edits show not to code together but allow 1 bypass edit - my understanding s this bypass edit is for a different location. I have read all the medical policies- along with related discussions, yet there is still gray muddled area. I have some forum answers stating that fluoroscopy is inclusive to these codes if both are done for same location and others contradict this - desperately seeking a absolute positive answer with possible reference fr the physician. Thanks!!!
 
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24
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Erie, PA
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still questioning 64418

I re-read CMS policy and 62311 and it definitely includes fluoroscopy but 64418 policy is still somewhat gray. Does it include fluoroscopy or not if procedure performed in the same area as needle placement. Thanks
 
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