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62311 and 77003

  1. Default 62311 and 77003
    Medical Coding Books
    My office has been getting numerous denials from blue shield stating that per the ama 77003 is bundled into 62310, 62311...etc. underneath the code is does state that the contrast is a part of, but no where does it state that the flouro is. i have have been searching for proof to send back to them but always come up short...if i could get some help i would greatly appreciate it...i have been searching the ama site but nothing comes up for me....

  2. #2
    Default
    I am having the same problem. Medicare is also denying 77003. I have not been able to find any thing on Medicare's website to help me. I did find some information on the ASA website if you search under fluoroscopic guidance. I have been using that to help with me appeals. Hope that helps.

    Their website is www.ASAhq.org.
    Missy Heuer CPC, CANPC

  3. #3
    Location
    Louisville, KY
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    You will continue to receive denials for this code pair. 62310-62319 include any fluoro guidance, contrast or related studies used in the administration of these services. While the code descriptor states "with or without contrast," it's inferential that fluoro falls into that category.

    My recommendation would be assure your facilities are only sending the injection service code out on claims. Any fluoroscopy billed in conjunction is putting the practice at risk for audits or sanctions as this is universally considered a bundled procedure.

    Good luck.

  4. #4
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    ENGLEWOOD/DENVER
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    After seeing Kevs response, I had look into this because I have been using fluoro with those codes forever.

    My research found the following:
    Code-Specific Reference Information

    AMA CPT® Assistant References
    Instructions

    Excludes fluoroscopic guidance and localization unless a formal contrast study is performed (77003)



    Injection of contrast during fluoroscopic guidance and localization is an inclusive component of codes 62263-62264, 62270-62273, 62280-62282, 62310-62319, 0027T. Fluoroscopic guidance and localization is reported by code 77003, unless a formal contrast study (myelography, epidurography, or arthrography) is performed, in which case the use of fluoroscopy is included in the supervision and interpretation codes.

  5. #5
    Default Fluroscopy
    The CPT Expert 2008 under the code 77003 there is a note that indicates: " Do not report with (0027T, 22526-22527, 62263-62254, 62270-62282, 62310-62319)"
    NoRaX

  6. #6
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    I guess now I'm confused again, in my CPT 2008 Professional Edition, under the code it states

    Injection of contrast during fluoroscopic guidance and localization (77003) is included in 22526, 22527, 62263, 62264, 62270-62282, 62310-62319, 0027T).

    Under the instructions in my Encoder it has the following which shows to seperate contradictory statements:

    Instructions - 77003

    Excludes neurolytic agent destruction (64600-64680)
    Excludes injection and needle/catheter placement, epidural/subarachnoid (62270-62282, 62310-62319) Excludes injection, paravertebral facet joint (64470-64476)
    Excludes transforaminal epidural needle placement/injection (64479-64484)
    Excludes sacroiliac joint arthrography (27096, 73542)
    Do not report with (0027T, 22526-22527, 62263-62264, 62270-62282, 62310-62319)

    Anybody else have any thoughts/supporting documentation???

  7. #7
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    Here is more documentation. Specifically page 9

    http://www.gehealthcare.com/usen/com...roPainMgmt.pdf

    I'm still looking for something other than the CPT expert that validates not billing them together (nothing personal but I figure if the AAPC does not back up the CPT expert, then the info contained therein is not substantiated).

  8. #8
    Location
    Louisville, KY
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    AMA sets the standards for CPT coding, not AAPC.

    I know that most Federal payers have edits that kick this combination out when billed by the same provider, same DOS. As I know it, this has always been a standard, since before 77003 we had 76005--which was also excluded as they [I]are not[I] formal studies, simply guidance procedures, included within the code descriptor.

    No offense taken, but I would never advocate the inclusion of both codes on a bill--this is a clear violation of AMA coding standards as stated within the manual.

    Good luck.

  9. Default
    This is the website i looked at after receving numerous denials. What I am trying to get at is the contrast in bundled not the guidance...i have only gotten conflicting info from blueshield...no other payer. It has been done this way for years with the 76005 and now the 77003, there is always going to be someone who reads the info just a bit worng and sets the whole thing off course.


    http://www.asahq.org/news/031907Fluoroupdate.pdf

    Page 3 2nd paragraph.
    Last edited by jessieindiego; 02-22-2008 at 11:53 PM.

  10. #10
    Location
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    Thank you!!!!

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