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EEk! Help! Question about 77003 (Fluoroscopy)

  1. Question EEk! Help! Question about 77003 (Fluoroscopy)
    Medical Coding Books
    Hey guys, just wondering if anyone is having problems getting paid on code 77003 when in combination with pain management codes. some of our worker comp companies dont want to pay for it and dont disclose a reason. anyone have any thoughts? it would be a great there maybe a bundling or global code? thanks sooooo much!

  2. #2
    Medicare and Mediciad usually bundle it, but I have had no issues with other payers.
    Walker Bachman, CPC, CPPM

  3. #3
    North Carolina
    Default Walker--->

    We just recently started performing trial stimulators. Everything that I'm reading suggests that fluro is bundled into 63650; particularly MCR/MCD. Is that your experience, too?

  4. #4
    Medicare bundles it in the facility bill (77003-TC), but pays it on the professional bill (77003-26)
    Walker Bachman, CPC, CPPM

  5. Default
    hmm i wonder why our workers comp insurance companies are giving us such a hard time? we list the pain management codes then the 77003 after them. i dont see the problem.

  6. #6
    I don't either. It could be your state doesn't have that code on the list of approved codes for work comp payment. We've run into that a few times when billing out of state work comp. (I'm in Georgia)
    Walker Bachman, CPC, CPPM

  7. #7
    North Carolina
    I have an article (Anesthesia and Pain: Anesthesia and Pain Coder's Pink Sheet, October 2009, Vol. 10, No. 10) dated 10-1-09


    Your physician may use fluoroscopic guidance when implanting neurostimulators. However, your best bet is to not bill fluoro codes separately when billing for the procedure. Billing guidelines are inconsistent on this point. In the CCI edits, some fluoro codes are bundled into some of the neurostimulator codes.

    The article recommends against reporting fluoro separately. In a non-published response to a private practice inquiry, the AMA confirmed that fluoroscopic guidance for spinal cord stimulators is considered to be part of the implantation procedure and not separately billable.

    CPT KnowledgeBase checked with NASS & AANS and both specialty groups supported that the radiologic guidance was not separately reportable - but considered to be part of the implantation code and as such included in the RVU calculation for the applicable implantation codes.


  8. #8
    I wonder why the CPT descriptor for code 63650 doesn't say that it includes flouro, like several other similar codes (e.g. 63661)
    Walker Bachman, CPC, CPPM

  9. Default
    i checked in the cpt book and 77003 can be billed separately using the epidural injection codes that we need and yet companies still won't pay the claims. 77003 seems to be bundled with other procedures but not epidurals...i bill for Pennsylvania, anyone else having these problems? thanks for the info!

  10. #10
    North Carolina
    Quote Originally Posted by Walker22 View Post
    I wonder why the CPT descriptor for code 63650 doesn't say that it includes flouro, like several other similar codes (e.g. 63661)
    I noticed that (63650) but CCI edits have the two bundled; however, a modifier is allowed in order to differentiate between the services. I'm just not comfortable adding a modifier because of this statement within the NCCI manual...

    "Radiological supervision and interpretation codes include all radiological services necessary to complete the service. CPT codes for fluoroscopy/fluoroscopic guidance (e.g., 76000, 76001, 77002, 77003) or ultrasound/ultrasound guidance (e.g., 76942, 76998) should not be reported separately."

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