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Old 06-23-2010, 09:17 AM
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Default 64510 w/ fluoro

Can our pain management physician use fluoroscopy 77002 with 64510 and 64520 or is it recommended to use 77003
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Old 06-23-2010, 09:56 AM
rkmcoder rkmcoder is offline
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Below is from the June 2008 CPT Asst (this shows the old facet codes which did not include fluoro):

Code 77002

Code 77002, Fluoroscopic guidance for needle placement (eg, biopsy aspiration, injection, localization device), is intended to be used to report fluoroscopic guidance during injection procedures when fluoroscopic guidance is required in the performance of needle placement in areas other than the spine, for pain management injection procedures. Codes 76000 and 76001 differ in that the descriptors do not specifically identify fluoroscopic guidance for a procedure involving needle or device placement. The organ or anatomic site is not specified for use of code 77002; therefore, fluoroscopic guidance as described by code 77002 may be performed in support of a procedure described, for example, by codes 20553, 20555, 20610, 51100-51102, 60100, and 62287, to name but a few. Code 62287 is included in the 77002 list because it is a spinal procedure and not a spinal injection.

To differentiate, code 77002 rather than code 77003 should be reported to identify the fluoroscopic guidance performed in conjunction with injection codes 64400- 64450, 64505-64530, 64600-64620, or 64630-64680, because this code more accurately describes the fluoroscopic guidance procedure performed for the anatomy involved. (ie, these types of injections are not included in the list in the 77003 code descriptor).

Code 77002 should not be reported separately with any radiographic arthrography (code 70332, 73040, 73085, 73115, 73525, 73580, or 73615) with the exception of computed tomography (CT) and magnetic resonance (MR) arthrography.

Code 77003

In contrast to code 77002, spine and paraspinous anatomic sites are specified in the descriptor of code 77003, Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint), including neurolytic agent destruction. Code 77003 describes fluoroscopic guidance of spinal or paraspinal injections, when fluoroscopy is performed for the purpose of guiding or localizing a needle or catheter tip for spinous or paraspinous injection procedures. Contrast may then be injected to determine whether the needle or catheter is in the correct place. When fluoroscopic guidance and localization for needle placement and injection is performed in conjunction with codes 64470-64476 and 64479-64484, code 77003 should be additionally reported. It would not be appropriate to report either code 76000 or 77002 in this circumstance. To further clarify, code 77003 is intended to be reported per spinal region (not per level).

Since codes 62263, 62264, and 0027T include fluoroscopic guidance and localization, code 77003 is not reported in addition to these percutaneous or endoscopic lysis of epidural adhesion procedures.

Richard Mann
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Old 06-23-2010, 03:45 PM
dwaldman dwaldman is offline
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77002 and 77003 are column two codes of 64510. It would not be appropriate to use the modifier 59. You would only report 64510 for a Medicare patient or a patient who has insurance which bases their edits on CCI. Personally I bill all carriers the same in regards to NCCI as the primary guide to what is allowed to be reported with a modifier and what should not be separately be reported.
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