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62311 and 77003

  1. Default 62311 and 77003
    Exam Training Packages
    In my Coding Expert book for 77003-in the ASC Payment Indicator it shows as N1- which is: "Packaged procedure/Item; no separate payment made." So, although it appears to not be bundled with the code 62311- it looks to be non-covered if in an ASC setting. (

  2. Default CPT Expert and CPT Pro
    The CPT Expert and CPT Pro give conflicting information regarding billing 77003 with 62311. I'm not sure if it's a typo or what- but I'm opting for listening to CPT Pro.

  3. #13
    Location
    Louisville, KY
    Posts
    1,101
    Default Devil's Advocate
    If contrast is included in the code descriptor, then what is left to report by using 77003?

  4. #14
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    the fluoroscopic guidance and localization of needle placement

  5. #15
    Location
    Louisville, KY
    Posts
    1,101
    Default
    Are your providers keeping hard copies of the needle placements/localization (e.g., films)?

  6. #16
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    Yes, mine do, I thought it was standard but I could be wrong on that. Hard copies are printed and kept within the facility as a part of the patients' medical record.

  7. #17
    Location
    Louisville, KY
    Posts
    1,101
    Default
    I opine with the payers on this topic: for the pro fees, it is inherent to the 60,000 series code. I believe the facility may have an additional charge (dependent upon the IP/OP status) based on if those films are actually maintained as permanent images, but see no clear need for the physicians to report 77003 as if it were an RS&I code . . .

  8. #18
    Location
    Denver Colorado
    Posts
    284
    Default 62311 and 77003
    The use of fluoroscopy for needle placement / guidance is NOT including into the 62310 - 62319 code range. There is an error in the Ingenix 2008 CPT book that is not in the official AMA CPT book. I sometimes wonder since UnitedHealth Care purchased Ingenix if we are going to see more of these types of "opps!"

    The American Society for Interventional Pain Practitioners has written a very strongly worded letter to BCBS for incorrectly bundling the fluoroscopic guidance into the epidural codes. Likewise the stance of the ASA in their position statement in October 2007.

    When the epidural codes were created in 2000, the RVU for use of fluoroscopy was NOT included in the RVU for the epidural injection procedures. There were and still are epidural injections performed without radiologic guidance, hence the RUC committee didn't want to allow higher RVU to providers that didn't use the fluoroscopic guidance. When we got the new 77003 code in 2007, the ONLY thing that changed was the CPT code number. The renumbering was done to "group" the needle guidance codes together in the radiologic section for easier computerized mapping.

    Providers using fluoroscopic guidance can or can not inject contrast during the needle guidance. The point of the parenthetical note is that the physician cannot report the injection of the contrast as a separate procedure.

    Appeal ALL denials from payers that bundle the fluoroscopy into the epidural injection for the provider services.

    The outpatient hospital and ASC facility billing has always included the fluoroscopic guidance into the grouper payment and now the APC. The technical component is not separately reimbursed but most certainly the professional component should be.

  9. Default
    Quote Originally Posted by marvelh View Post
    The use of fluoroscopy for needle placement / guidance is NOT including into the 62310 - 62319 code range. There is an error in the Ingenix 2008 CPT book that is not in the official AMA CPT book. I sometimes wonder since UnitedHealth Care purchased Ingenix if we are going to see more of these types of "opps!"
    ...
    Did UnitedHealth Care buy the AMA!@#?

    "The November 2010 issue of CPT Assistant caused major consternation among pain physicians. In answer to a question regarding the reporting of fluoroscopic guidance, the publication stated that fluoroscopic guidance was bundled with the translaminar epidural injections, CPT 62310-62319, and was not separately payable.

    The inclusion of fluoroscopic guidance in the payment for 62310-62319 appeared more than revolutionary – it seemed wrong. ASA followed up with CPT Assistant staff and quickly obtained a formal correction."

    As if we needed more confusion!

  10. #20
    Location
    Denver Colorado
    Posts
    284
    Default
    The CPT Assistant published a "retraction" / correction in the January 2011 issue regarding this erroneous article. Also the correction is available as a PDF file on the AMA letterhead for appealing denials at - http://tinyurl.com/AMACPTAssistantNov10errata

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