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Lumbar RFA with Fluoroscopic guidance

  1. #1
    Default Lumbar RFA with Fluoroscopic guidance
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    Good Morning,
    Is fluoroscopic guidance mandatory when doing an RFA? We received an audit for 2010 cases. Code 77003 does not come up in the CCI edits for code 64622 on our Encoder.

    If it is not mandatory to be done with fluoroscopy does anyone know of any articles or such that could help prove our point. Thank you.
    Missy Heuer CPC, CIRCC, CANPC

  2. Default
    What do you mean is fluoroscopic guidance "mandatory"?
    If it was performed, then yes capture 77003.
    If it was not performed then you would not bill the fluoroscopic guidance code.

    Using Encoder Pro, when you open the page for 64622 and scroll down to the "Instructions" section it says "Radiology crosswalk 77003".

    I am a little unclear on what your question is, but I hope this information helps.
    Tracey Thompson, CPC, CPPM

  3. #3
    On the charge sheet they did not state Fluoroscopic guidance so we only billed the 64622. Now they are pulling back payment stating that the RFA needed to be done with Fluoro.

    We have looked back at our CPT books and such and haven't been able to find anything that suggests that the RFA needs to be done with fluoroscopic guidance to be paid. I just wanted some confirmation that we did bill correctly and that they did not need to use fluoro with the RFA.
    Missy Heuer CPC, CIRCC, CANPC

  4. Default
    I am in no way an expert, but these are my thoughts...

    I would think that it would be fraudulent to bill something (fluoro) that was not documented. I would also think that it would be at the provider's discretion whether or not fluoro was required to perform the procedure.

    While I am sure you have already done this, the only advice I can give is to speak to the insurance company and explain the situation. If they are adamant that fluoro is required, ask for their documentation to support their reasoning.

    Hope this helps!
    Tracey Thompson, CPC, CPPM

  5. #5
    I would assume the RAC is using the local coverage determination policy that could state or imply that for a proper outcome of the procedure, fluoroscopic guidance would be necessary to perform ablation procedure of the facet joint nerves.

    I agree that you would appeal the recoupment stating that the documentation (procedure note) does support that fluoroscopic guidance was used and it was mistakenly not reported using 77003.

  6. #6
    In 2012 image guidance required and included similiar to 64490-64495

    64633 Destruction by neurolytic agent, paravertebral facet
    joint nerve(s), with imaging guidance (fluoroscopy or
    CT); cervical or thoracic, single facet joint

    +64634 …cervical or thoracic, each additional facet joint
    (List separately in addition to code for primary

    64635 Destruction by neurolytic agent, paravertebral facet
    joint nerve(s), with imaging guidance (fluoroscopy or
    CT); lumbar or sacral, single facet joint

    +64636 … lumbar or sacral, each additional facet joint (List
    separately in addition to code for primary procedure)

  7. #7
    WPS LCD. We had them request money on one date of service because it was billed wiouth out the fluoro guidance. We just sent in the notes showing it was indeed done with fluoro we just missed billing and that was sufficient and no money had to be refunded.

    During this procedure a needle is placed in the facet joint under fluoroscopic or CT guidance and a long acting local anesthetic agent is injected in the facet joint or around or into the nerve supplying the joint, to temporarily anesthetize the facet joint. After satisfactory blockade of the pain has been obtained, the patient is asked to indulge in the activities that usually aggravated his/her pain and to record his/her impressions of the effect of the procedure 4-8 hours after the injection. Temporary or prolonged significant pain relief of the back pain suggests that facet joints were the source of the symptoms and appropriate treatment may be prescribed

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