In January, one of the ladies I work with also works in a radiology department during the night time. She told me in January that there was Memo sent out to the employees explaining that when the doctors performs a fluoroscopically-assisted placement of a percutaneous electrode/63650, that they were no longer to put the charge master number in for any radiolgoical service (eg 77003, 77002, 76000).
I let her know that this was because the coding department at that hospital had seen CPT Assistant and knew that fluoroscopic guidance was part of performing the procedure and not separately reportable. That although the radiologist will dictate a small report stating fluoroscopic image of needle place by PM physician and the anatomically location, that with the change in coding guidlines that they had to follow these guidelines and no longer can they just key in the charge master number because too many would have to be corrected before the claims went out.
It is the same in your case, 64490 includes image guidance. There is not a professional and technical portion for radiology to report for this procedure. It is not well Medicare won't pay for but there are still some carriers that do. It is required and included in the code. They will have to understand this one procedure they will not be able to report on their side.
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