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RFA of the GON with Fluoroscopy

  1. #1
    Default RFA of the GON with Fluoroscopy
    Medical Coding Books
    I have a provider that did a RFA of the Medical Branch Nerves Cervical. C2, C3, C4, C5 and C6 Left. He also did a RFA of the Left Occipital Nerve. He billed this as;
    64626-LT x 1
    64627-LT x 4
    The insurance is denying the 77002-59. Could someone give me an idea why?
    Thanks for your help.

  2. #2
    3. CPT codes 76942, 77002, 77003, 77012, and 77021 describe radiologic guidance for needle placement by different modalities. CMS payment policy allows one unit of service for any of these codes at a single patient encounter regardless of the number of needle placements performed. The unit of service for these codes is the patient encounter, not number of lesions, number of aspirations, number of biopsies, number of injections, or number of localizations.

    1. NCCI states fluoro should be reported one time per case.
    2. Most non-Medicare payers have a verison of edits that is similar to NCCI or is more restrictive to bypass of the edits. With the fact these are mutually exclusive, non medicare payors are less likely to accept the 59 modifier.
    3. 77003 per the AMA is per spinal region. Although you are using 77002, the anatomical location is very close in relation to the RF of the medial branches.
    4. I would accept the carrier's adjustment for 77002

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