RADIOLOGIC GUIDANCE FLUOROSCOPIC GUIDANCE
77001 Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position) (List separately in addition to primary procedure) (Do not use 77001 in conjunction with 77002)
77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device)
(77002 includes all radiographic arthrography with the exception of supervision and interpretation for CT and MR arthrography) (Do not report 77002 in addition to 70332, 73040, 73085, 73115, 73525, 73580, 73615)
(77002 is included in the organ/anatomic specific radiological supervision and interpretation procedures 49440, 74320, 74355, 74445, 74470, 74475, 75809, 75810, 75885, 75887, 75980, 75982, 75989)
77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (Injection of contrast during fluoroscopic guidance and localization [77003] is included in 22526, 22527, 62263, 62264, 62267, 62270-62282, 62310-62319) (Do not report 77003 in conjunction with 64479-64484, 64490-64495)
Coding Guidelines
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
The fluoroscopic guidance code 77003 descriptor was revised and “transforaminal epidural” deleted from the descriptor. A new parenthetical was added to note that you should not use 77003 in conjunction with 64479-64484, 64490-64495 as fluoroscopy has been bundled into these codes. An additional parenthetical was added to emphasize that fluoroscopy codes 77001, 77002 and 77003 should not be reported when fluoroscopic guidance is included in the descriptor.
MAGNETIC RESONANCE GUIDANCE
77021 Magnetic resonance guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation
77022 Magnetic resonance guidance for, and monitoring of, parenchymal tissue ablation
Radiology p Modifier Example
*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) * Physician services billing:
62310 x 1 62310 x 1
77003 -26 x 1
*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)
77003 Fluoroscopic guidance and localization of needle or catheter tip p for s ine or paraspinous diagnostic or therapeutic
injection procedures (epidural, subarachnoid) * Global RVU (2014) 2.54
– Professional component (-26) 0.86
– Technical component (-TC) 1.68
* Used only for injections referenced in descriptor or specificall directed b CPT parenthetical notes specifically directed by CPT parenthetical notes
January 2011 CPT Assistant: … code 77003 is reported in conjunction with codes conjunction with codes 62267, 62270-62273, 62280-62282, and 62310-62319, when fluoroscopic guidance is necessary and performed with these injection, drainage or aspiration 63 procedures.
Medicare NCCI Edits
* 77003 is a column 2 code (component) of the following column 1 (comprehensive) pain management procedure codes:
– 0213T – 0219T – 62263 – 62364 – 64510
– 0228T – 0231T
– 22520 – 22521 22523 22524
– 62290 – 62291
– 62350 – 62351
62355
– 64520
– 64530
– 22523 – 22524 64633 64636
– 22526 – 22527
– 27096
– 62355
– 64479 – 64484
– 64490 – 64495
– 64633 – 64636
– 64680 – 64681
27096 64490 64495
– NCCI bundling edits do carry a modifier indicator of “1” BUT the fluoroscopic guidance must be used with a separate and distinct procedure in order to bypass the edits!
Medicare NCCI Edits & 77003
* Left L4-L5 transforaminal epidural injection with fluoroscopic guidance
– Compliant coding: 64483 – LT x 1
– NOT: 64483 – LT x 1 and 77003 – 59 x 1
* Incorrect use of modifier 59 to bypass NCCI bundling edits;
fluoroscopic guidance was not used with a separate and distinct / different procedure distinct / different procedure
* Left L4-L5 transforaminal epidural injection with fluoroscopic guidance AND C7-T8 interlaminar epjidural injection with fluoroscopic guidance – Compliant coding:
64483 – LT x 1
62310 x 1
77003 – 59 x 1
Image Guidance: Image Guidance: 77003 Fluoroscopy Fluoroscopy * CPT Parenthetical notes
– Injection of contrast during fluoroscopic guidance and Injection of contrast during fluoroscopic guidance and localization [77003] is included in 22526, 22527, 27096, 62263, 62264, 62267, 62270-62282, 62310-62319
– Fluoroscopic guidance for subarachnoid puncture for diagnostic radiographic myelography is included in the supervision and interpretation codes 72240-72270
– Do not report 77003 in conjunction with 27096, 64479- 64484, 64490-64495, 64633-64636
– For percutaneous or endoscopic lysis of epidural adh i es ons, 62263, 62264 i ld nc u e fl i id fluoroscopic guidance
and localizations
Image Guidance: 77003 Fluoroscopy Image Guidance: Guidance: 77003 Fluoroscopy Fluoroscopy
* Spine and Spinal Cord: Injection, Drainage, or Aspiration CPT Section Guidelines
– Injection of contrast during fluoroscopic guidance and localization is an inclusive component in 62263, 62264, 66267, 62270-62273, 62280-62282, 62310- 62319.
* Does NOT mean that fl i uoroscopic guid i ances included, rather the injection of contrast is contrast is what is included
