# Nerve blocks (64400 - 64450) with fluoroscopic guidance 77002



## millortsui

Default Nerve blocks (64400 - 64450) with fluoroscopic guidance 77002
Please enlighten me here. In the CPT book, it does not indicate fluoroscopic guidance (77003) is included in cpt code 64400 - 64450. Insurance company/Medicare always denies payment on this combination. When we code it with ultrasound guidance (76942), insurance always pays for it.

I understand that 76942 and 77003 are mutual exclusive.

Can anyone please educate me in here?

Thanks,
Millor


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## dwaldman

If you would reference CPT Assistant 2008 it states:

"Code77002, 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."

But when billing Medicare or a carrier that states they follow the NCCI edits, 77002 is inclusive component when utilized to perform many codes from the 64400-64450 range. 

Below is an important statement from the NCCI policy manual chapter 9

"3. 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."

Additionally from Chapter 1

I. CPT Manual and CMS Coding Manual Instructions
CMS often publishes coding instructions in its rules, manuals, and notices. Physicians must utilize these instructions when reporting services rendered to Medicare patients.
The CPT Manual also includes coding instructions which may be found in the “Introduction”, individual chapters, and appendices. In individual chapters the instructions may appear at the beginning of a chapter, at the beginning of a subsection of the chapter, or after specific CPT codes. Physicians should follow CPT Manual instructions unless CMS has provided different coding or reporting instructions.
The American Medical Association publishes CPT Assistant which contains coding guidelines. CMS does not review nor approve the information in this publication. In the development of NCCI edits, CMS occasionally disagrees with the information in this publication. If a physician utilizes information from CPT Assistant to report services rendered to Medicare patients, it is possible that Medicare Carriers (A/B MACs processing practitioner service claims) and Fiscal Intermediaries may utilize different criteria to process claims.

________________________________________________________________

In regards to mutually exclusive edits such as U/S and Fluroscopy the definition of this edit can help clarify the by example of one the reasons behind mutually exclusive edits---considering that they would not expect to be billed for two different image modalities for the same procedure. 

"Mutually exclusive procedures cannot reasonably be performed at the same anatomic site or same patient encounter. An example of a mutually exclusive situation is the repair of an organ that can be performed by two different methods. Only one method can be chosen to repair the organ"


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## millortsui

I have looked through the NCCI edit online as follow as Jan 1 to today :

col 1           col 2                 effective    deletion   Modifier
                                            date         date
64400	77002		20100101	    *	        1
64400	90760		20060101	20081231	1
64400	90765		20060101	20081231	1

For the date of service, we only use the fluoroscopic guidance once without US guidance.


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## dwaldman

"Code 77002 is a component of Column 1 code 64400 but a modifier is allowed in order to differentiate between the services provided." 
 IThe fact that 77002 was utilized to perform 64400, modifier 59 would not be appropriate and only 64400 could be reported. I ran both codes together in code check with verison 17.2 for dates of service July 1st and forward the codes  look like they are still bundled.


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## millortsui

Thanks!


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