| CPT Code and Description | When Not to Report the Code Separately | When to Report the code Separately | Other |
| All anatomical areas except the spine 77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) | CPT code 76003 should not be reported separately with any radiographic arthrography (CPT 70332, 73040, 73085, 73115, 73525, 73580, 73615) with the exception of supervision and interpretation for CT and MR arthrography. | Report this code when fluoroscopic guidance is required in the performance of needle placement in areas other than spine, for pain management injection procedures. CPT code 77002 should be reported in conjunction with the primary pain management procedure. | Injection of contrast during fluoroscopic guidance is an inclusive component and is not separately reported. |
| Spine 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. | CPT code 77003 should not be reported separately with myelography, epidurography, arthrography, or discography. | Report this code when fluoroscopic guidance is required in the performance of spinal or paraspinous injection procedures, as long as these procedures are not myelography, epidurography, arthrography or discography. CPT code 76005 should be reported in conjunction with injection codes (CPT 62270-62273, 62280- 62282, 62310-62319, 64470-64476, 64479- 64484 and 64622-64627; and in certain circumstances with CPT 27096). | Injection of contrast during fluoroscopic guidance and localization is an inclusive component and is not separately reported. Reported per spinal region (e.g., cervical, lumbar), and not per level. |
77002 - Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) average fee amount - $90 - $100
77003 - Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) average fee amount - $80 - $100
76003 Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device)
In 2010, there were major changes to the Facet Injection codes, and the Medicare ASC List fee schedule is reimbursing significantly less for these procedures. These codes include the use of imaging, so the 77003 Fluoroscopy or other imaging technique codes are not billed separately with the new codes. These codes have a different code for each level billed. The last code allowable for each spinal area (i.e., Cervical, Lumbar, etc.) is for the 3rd level and the code states that it “cannot be billed more than once per day,”
Billing and Coding Guidelines
An imaging guidance code is billed only once per session for CPT code 77003, fluoroscopy or CPT code 77012 for CT guidance. Physicians may only bill for the professional component when imaging is performed in a hospital or non-office facility. No claim should be submitted for the hard or digital film(s) maintained to document needle placement.
The CPT code 72275 (Epidurography, radiological supervision and interpretation) differs from CPT code 77003 in that it represents a formal recorded and reported contrast study that includes fluoroscopy. Epidurography should only be reported when it is reasonable and medically necessary to perform a diagnostic study. Epidurography should not be billed when the contrast injection is part of the fluoroscopic guidance and contrast injection to confirm correct needle placement that is integral to the epidural, transforaminal and intrathecal injections addressed in the policy.
For example, CPT code 70332 describes radiological supervision and interpretation of a temporomandibular joint arthrogram. The CPT Manual instruction following CPT code 70332 states: “(Do not report 70332 in conjunction with 77002).” Therefore, CPT code 77002 (Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device)) is bundled into CPT code 70332.
Misuse of column two code with column one code - For example, CPT code 76930 describes imaging supervision and interpretation for ultrasound guidance for pericardiocentesis. CPT code 77002 describes fluoroscopic guidance for needle placement. Since imaging supervision and interpretation codes include all radiological services necessary to complete the service, it is a misuse of CPT code 77002 to report it separately with CPT code 76930. Therefore, CPT code 77002 is bundled into CPT code 76930.
1. The HCPCS/CPT code(s) may be subject to Correct Coding initiative (CCI) edits. This policy does not take precedence over CCI edits. Please refer to the current version CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.
2. All procedures related to pain management procedures performed by the physician/provider performed on the same day must be billed on the same claim.
3. An imaging guidance code is billed only once per session for CPT code 77003, fluoroscopy or CPT code 77012 for CT guidance. Physicians may only bill for the professional component when imaging is performed in a hospital or non-office facility. No claim should be submitted for the hard or digital film(s) maintained to document needle placement.
4. The CPT code 72275 (Epidurography, radiological supervision and interpretation) differs from CPT code 77003 in that it represents a formal recorded and reported contrast study that includes fluoroscopy. Epidurography should only be reported when it is reasonable and medically necessary to perform a diagnostic study. Epidurography should not be billed when the contrast injection is part of the fluoroscopic guidance and contrast injection to confirm correct needle placement that is integral to the epidural, transforaminal and intrathecal injections addressed in the policy.
ADVISORY PANEL ON AMBULATORY PAYMENT CLASSIFICATION (APC) GROUPS
The Panel recommends that CMS maintain the packaged status of the following:
• CPT code 76001, Fluoroscopy, physician time more than one hour, assisting a nonradiologic physician (e.g., nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy)
• CPT code 76003, Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device)
• CPT code 76005, 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.
Anthem Central Region Clinical Claims
Subject: Fluoroscopic Guidance for Needle Placement (e.g., Biopsy, Aspiration, Injection, Localization Device) with Magnetic Resonance (e.g., Proton) any Joint of Upper Extremity; with Contrast Material(s) or with Injection Procedure for Shoulder Arthrography or Enhanced CT/MRI Shoulder Arthrography.
76003 (Fluoroscopic guidance for needle placement{e.g., biopsy, aspiration, injection, localization device}) does not bundle with 73222 (Magnetic resonance [e.g., proton}, any joint of upper extremity; with contrast material(s).
76003-26 (Fluoroscopic guidance for needle placement{e.g., biopsy, aspiration, injection, localization device}) does not bundle with 73222-26 (Magnetic resonance [e.g., proton}, any joint of upper extremity; with contrast material(s).
76003-TC (Fluoroscopic guidance for needle placement{e.g., biopsy, aspiration, injection, localization device}) does not bundle with 73222-TC (Magnetic resonance [e.g., proton}, any joint of upper extremity; with contrast material(s).
76003 (Fluoroscopic guidance for needle placement {e.g., biopsy, aspiration, injection, localization device}) does not bundle with 23350 (Injection procedure for shoulder arthrography or enhanced CT/MRI shoulder arthrography).
76003-26 (Fluoroscopic guidance for needle placement {e.g., biopsy, aspiration, injection, localization device}) does not bundle with 23350-50 (Injection procedure for shoulder arthrography or enhanced CT/MRI shoulder arthrography).
76003-26 (Fluoroscopic guidance for needle placement {e.g., biopsy, aspiration, injection, localization device}) does not bundle with 23350-LT (Injection procedure for shoulder arthrography or enhanced CT/MRI shoulder arthrography).
76003 (Fluoroscopic guidance for needle placement {e.g., biopsy, aspiration, injection, localization device}) does not bundle with 23350-RT (Injection procedure for shoulder arthrography or enhanced CT/MRI shoulder arthrography).
Anthem Central Region does not bundle 76003 with 73222, does not bundle 76003-26 with 73222-26, and does not bundle 76003-TC with 73222-TC. Based on CPT article, Coding Clarification, Radiology Procedures, it states:
“It is important to note that MRI obtained after intraarticular administration of contrast (MR arthrography) should be coded as a "with contrast examination." In addition, it is appropriate to report the appropriate procedure code and guidance code (if used) for injection of contrast into the joint. For instance, to report an MRI of the shoulder with intra-articular contrast (MR arthrography of the shoulder), it is appropriate to report 23350 for the shoulder joint injection. You would report 76003 if fluoroscopic guidance was used to guide needle placement into the joint, and 73222 for the MRI shoulder with contrast.”
Based on the National Correct Coding Initiative Edits, code 76003 is not listed as a component code to code 73222. Therefore, if 76003 is submitted with 73222—both reimburse separately, if 76003-26 is submitted with 73222-26—both reimburse separately, if 76003-LT is submitted with 73222-LT—both reimburse separately, if 76003-RT is submitted with 73222-RT—both reimburse separately and if 76003- TC is submitted with 73222-TC—both reimburse separately.
Anthem Central Region does not bundle 76003 with 23350, does not bundle 76003-26 with 23350-50, does not bundle 76003-26 with 23350-LT and does not bundle 76003-26 with 23350-RT. Based on the National Correct Coding Initiative Edits, code 76003 is not listed as a component code to code 23350. Therefore, if 76003 is submitted with 23350—both reimburse separately, if 76003-26 is submitted with 23350-50 .
Whether there should be reimbursement for CPT codes 27299-51, 22899-51, 38230, 95920, 95937 and 76003 for date of service 03-05-04.
RATIONALE
CPT code 27299-51 date of service 03-05-04 denied with denial code “G/X815” (this procedure is incidental to the primary procedure, and does not warrant separate reimbursement). The carrier’s position states that code 27299-51 is part of the global service package per the American Academy of Orthopaedic Surgeons-Complete Global Service Data Handbook pg. IX#9. Per Ingenix EncoderPro CPT code 27299-51 is not a global procedure code. Per Rule 133.1(a)(8) fair and reasonable reimbursement – the carrier did not state an amount. Reimbursement is recommended per the Medical Fee Schedule effective 08-01-03 in the amount of $1400.00.
CPT code 22899-51 date of service 03-05-04 denied with denial code “G/X815” (this procedure is incidental to the primary procedure, and does not warrant separate reimbursement). The carrier’s position states that code 22899-51 is part of the global service package per the American Academy of Orthopaedic Surgeons-Complete Global Service Data Handbook pg. IX#9. Per Ingenix EncoderPro CPT code 22899-51 is not a global procedure code. Per Rule 133.1(a)(8) fair and reasonable reimbursement – the carrier did not state an amount. Reimbursement is recommended per the Medical Fee Schedule effective 08-01-03 in the amount of $1200.00.
CPT code 38230 date of service 03-05-04 denied with denial code “G/X815” (this procedure is incidental to the primary procedure, and does not warrant separate reimbursement). The carrier’s position states that code 38230 is part of the global service package per the American Academy of Orthopaedic Surgeons-Complete Global Service Data Handbook pg. X. Per Ingenix EncoderPro CPT code 38230 is not a global procedure code. The MAR per the Medical Fee
MDR Tracking #: M5-05-0126 01 Schedule effective 08-01-03 is $366.39 ($293.11 X 125%), however the requestor billed $183.19, therefore this is the recommended amount of reimbursement.
CPT codes 95920 and 95937 date of service 03-05-04 denied with denial code “G/X815” (this procedure is incidental to the primary procedure, and does not warrant separate reimbursement). Per Ingenix EncoderPro CCI edits CPT codes 95920 and 95937 are global to CPT code 22612 which was the primary procedure billed per the EOB. No reimbursement is recommended. CPT code 76003 date of service 03-05-04 denied with denial code “G/X815” (this procedure is incidental to the primary procedure, and does not warrant separate reimbursement).
The carrier’s position states that code 76003 is part of the global service package per the American Academy of Orthopaedic Surgeons-Complete Global Service Data Handbook pg.viii#6. Per Ingenix EncoderPro CPT code 76003 is not a global procedure code. Reimbursement per the Medical Fee Guideline effective 08-01-03 in the amount of $98.08 ($78.46 X 125%) is recommended.
IV. DECISION
Based upon the review of the disputed healthcare services within this request, the Division has determined that the requestor is entitled to reimbursement for CPT codes 27299-51, 22899-51, 38230 and 76003. The Division has determined that the requestor is not entitled to reimbursement for CPT codes 95920 and 95937.
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