# question on fluoro guidance



## Anna Weaver (May 7, 2009)

I am just starting to code for pain management and have a question. This Dr. did 64470-50 and 64483-50 both with fluoro guidance. Since this is lumbar and cervical, CPT says I can bill each region. Is a modifier (59?) needed, do you bill 77003 x 2 (single line) or do you bill 77003, 77003 with no modifier? This patient is medicare primary and they usually don't like the single line so not sure where to go from here. 
Your help appreciated. Thanks


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## RebeccaWoodward* (May 7, 2009)

Anna,

There are no bundling issues for 64470/64483.  I would add modifier 51 to64470 since it has leser RVU's.  As for 77003...I have to play around with these.  Some of my carriers want units of 2 and some require two lines with 59 on the second 77003.  Since this is Medicare, I would post...

64483-50
64470-51/50
77003 
77003-59

(My MCR carrier prefers this way too)


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## Anna Weaver (May 7, 2009)

*fluoro*

Rebecca,
As always your help is invaliable. I truly appreciate all you do on here. Just wanted you to know that! 
Thanks!
Anna


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## RebeccaWoodward* (May 8, 2009)

Likewise Anna...You and others constantly make my day!


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## NIENAJADLY (May 15, 2009)

Just an FYI, our FL Medicare carrier will only pay for one 77003 per day even if different anatomical areas.  Not sure if this would apply for you or not, but might want to check with your carrier to see if they will pay for 2.


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## RebeccaWoodward* (May 15, 2009)

How unfortunate...our carrier actually has a different view on this.

*March 3, 2009*

*Facet Joint Injections and Fluoroscopy*

A recent review of providers billing for facet joint injections indicated that some were being performed in unusual places of service and without fluoroscopic guidance. The AMA RVRBS Data Manager 2009, as well as advice from the society of Interventional Pain Management, and the current standard of care, clearly indicates that the CPT® codes used for this procedure require the use of fluoroscopy to properly place the injection. 

Effective 01 March 2009, CIGNA Government services will not longer pay claims submitted for facet joint injections at any level *unless the corresponding CPT® code for fluoroscopy is also performed and billed.* Document supporting the use of fluoroscopy should be maintained should CIGNA Government Services or other oversight agency wish to review same. 

The inappropriate use of facet joint injections is an item of concern for some oversight agencies. Providers are encouraged to make sure that the documentation supports the medical necessity and reasonableness and frequency of such injections.


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