Monday, September 26, 2016

CPT code 77002, 77003 - Fluoroscopic guidance

 Procedure CODE and description

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

Coding Guidelines 

An imaging guidance code is billed only once per session for Procedure code 77003, fluoroscopy or Procedure 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 Procedure code 72275 (Epidurography, radiological supervision and interpretation) differs from Procedure 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, Procedure code 70332 describes radiological supervision and interpretation of a temporomandibular joint arthrogram. The Procedure Manual instruction following Procedure code 70332 states: “(Do not report 70332 in conjunction with 77002).” Therefore, Procedure code 77002 (Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device)) is bundled into Procedure code 70332.

Misuse of column two code with column one code - For example, Procedure code 76930 describes imaging supervision and interpretation for ultrasound guidance for pericardiocentesis. Procedure 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 Procedure code 77002 to report it separately with Procedure code 76930. Therefore, Procedure code 77002 is bundled into Procedure code 76930.


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.

Radiological supervision and interpretation codes include all radiological services necessary to complete the service. CPT codes for fluoroscopy/fluoroscopic guidance (e.g., 76000, 76001, 77002, 77003) or ultrasound/ultrasound guidance (e.g., 76942, 76998) should not be reported separately. Radiological guidance procedures include all radiological services necessary to complete the procedure. CPT codes for fluoroscopy (e.g., 76000, 76001) should not be reported separately with a fluoroscopic guidance procedure. CPT codes for ultrasound (e.g., 76998) should not be reported separately with an ultrasound guidance procedure. A limited or localized followup computed tomography study (CPT code 76380) should not be reported separately with a computed tomography guidance procedure.


General Policy Statements

Radiological supervision and interpretation codes include all radiological services necessary to complete the service. Procedure codes for fluoroscopy/fluoroscopic guidance (e.g., 76000, 76001, 77002, 77003) or ultrasound/ultrasound guidance (e.g., 76942, 76998) should not be reported separately.

Radiological guidance procedures include all radiological services necessary to complete the procedure. Procedure codes for fluoroscopy (e.g., 76000, 76001) should not be reported separately with a fluoroscopic guidance procedure. Procedure codes for ultrasound (e.g., 76998) should not be reported separately with an ultrasound guidance procedure. A limited or localized followup computed tomography study (Procedure code 76380) should not be reported separately with a computed tomography guidance procedure.


Radiology  Modifier Example

ƒ Caudal epidural injection performed under fluoroscopic guidance fluoroscopic guidance

– Place of Service: physician office (POS 11)

62310 x 1 62310 x 1
77003 x 1 (guidance billed with no modifier)


– Place of service: Ambulatory Surgery Center (POS 24) 
Place of service: Ambulatory Surgery Center (POS 24) ƒ Physician services billing:
62310 x 1 62310 x 1
77003 -26 x 1

ƒ ASC facility billing: ASC facility billing:

62310 x 1
77003 –TC x 1 (separately billable will depend upon payer policy) (separately billable will depend upon payer policy


Joint Injection for Intra-articular Contrast Enhanced CT or MR

If fluoroscopic guidance is performed for a joint injection for intra-articular contrast enhanced CT or MR arthrography and no conventional radiographic arthrography procedure is performed, it is appropriate to separately report the fluoroscopic guidance code. The fluoroscopy used for an intra-articular injection for an enhanced CT or enhanced MR arthrography (typically a mixture of saline, marcaine and nonionic contrast media and/or gadolinium) involves additional physician work. This physician work is separate  from the work included in the monitoring and interpretation of the contrast enhanced images included in the CT or MR “with contrast” procedures. For example, a CT with contrast arthrography (without anesthesia) study of the hip would be reported with 27093 for the injection, 77002 for the fluoroscopic guidance and 73701 for the CT with contrast arthrogram.


Note that when combined CT or MRI and conventional radiographic arthrography studies are performed, it would not be appropriate to report the fluoroscopic guidance code separately. As mentioned previously, the fluoroscopic guidance for needle placement is included in the arthrography RS&I code (70332, 73040, 73085, 73115, 73542, 73525, 73580, 73615). For example, a combined radiographic and CT with contrast arthrography of the knee would be reported with Procedure code 27370 for the injection, 73580 for the conventional radiographic arthrography, and 73701 for the CT arthrography. In this scenario, the RS&I code, 73580, includes fluoroscopy; therefore, code 77002 is not reported separately.

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