# EEk! Help! Question about 77003 (Fluoroscopy)



## nancpanc01 (Jan 20, 2010)

Hey guys, just wondering if anyone is having problems getting paid on code 77003 when in combination with pain management codes. some of our worker comp companies dont want to pay for it and dont disclose a reason. anyone have any thoughts? it would be a great help...is there maybe a bundling or global code? thanks sooooo much!


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## Walker22 (Jan 20, 2010)

Medicare and Mediciad usually bundle it, but I have had no issues with other payers.


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## RebeccaWoodward* (Jan 20, 2010)

*Walker--->*

Walker,

We just recently started performing trial stimulators.  Everything that I'm reading suggests that fluro is bundled into 63650; particularly MCR/MCD.  Is that your experience, too?


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## Walker22 (Jan 20, 2010)

Medicare bundles it in the facility bill (77003-TC), but pays it on the professional bill (77003-26)


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## nancpanc01 (Jan 20, 2010)

hmm i wonder why our workers comp insurance companies are giving us such a hard time? we list the pain management codes then the 77003 after them. i dont see the problem.


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## Walker22 (Jan 20, 2010)

I don't either. It could be your state doesn't have that code on the list of approved codes for work comp payment. We've run into that a few times when billing out of state work comp. (I'm in Georgia)


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## RebeccaWoodward* (Jan 20, 2010)

I have an article (Anesthesia and Pain: Anesthesia and Pain Coder's Pink Sheet, October 2009, Vol. 10, No. 10) dated 10-1-09 

Excerpt-(paraphrased)....

Your physician may use fluoroscopic guidance when implanting neurostimulators. However, your best bet is to *not* bill fluoro codes  separately when billing for the procedure. Billing guidelines are inconsistent on this point. In the CCI edits, some fluoro codes are bundled into some of the neurostimulator codes.

The article recommends against reporting fluoro separately. In a *non-published* response to a private practice inquiry, the AMA confirmed that fluoroscopic guidance for spinal cord stimulators is considered to be part of the implantation procedure and not separately billable.

CPT KnowledgeBase checked with NASS & AANS and both specialty groups supported that the radiologic guidance was not separately reportable - but considered to be part of the implantation code and as such included in the RVU calculation for the applicable implantation codes.

Thoughts?


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## Walker22 (Jan 20, 2010)

I wonder why the CPT descriptor for code 63650 doesn't say that it includes flouro, like several other similar codes (e.g. 63661)


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## nancpanc01 (Jan 21, 2010)

i checked in the cpt book and 77003 can be billed separately using the epidural injection codes that we need and yet companies still won't pay the claims. 77003 seems to be bundled with other procedures but not epidurals...i bill for Pennsylvania, anyone else having these problems? thanks for the info!


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## RebeccaWoodward* (Jan 21, 2010)

Walker22 said:


> I wonder why the CPT descriptor for code 63650 doesn't say that it includes flouro, like several other similar codes (e.g. 63661)



I noticed that (63650) but CCI edits have the two bundled; however, a modifier is allowed in order to differentiate between the services. I'm just not comfortable adding a modifier because of this statement within the NCCI manual...

"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."


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## halebill (Jan 22, 2010)

Radiology is definitely not my specialty, but I do plenty of worker's comp. In regards to the original question, keep in mind that billing your everyday commercial insurance companies and Medicare/Medicaid, versus worker's comp, is like football vs. rugby. WC carriers have to follow the guidelines and fee schedule of each state's WC commission. Here in South Carolina, we working off a *2003* WC fee schedule. In addition, other bundling guidelines exist, such as, established outpatient visits are not payable is a procedure is performed. And that's ANY procedure. Examine your state's WC guidelines carefully, or request a copy of the particular guideline that a carrier is referring to for a denied charge. It's a whole different ballgame.

Bill Hale, CPC


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## bench (Jan 22, 2010)

I get paid with WC using 76003-TC for ASC. Hope this help.


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## KimberlyLanier (Apr 13, 2010)

Hi Rebecca,

I work for Pain Management Group and Anesthesia and was wondering if you might have a copy of Anesthesia and Pain Coder's Pink Sheet for October 2009, Vol. 10, No. 10 Dated 10-01-09 that you could please share.

Thanks Kim CPC  Fax 239-261-4232  Collier Anesthesia PA Naples


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## Kevinph84 (Apr 15, 2010)

*Payment Indicators*

77003 has a payment indicator of NI. This payment indicator states that the service is bundled into a payment for the procedure. Some payers do reimburse for the 77003, but from my experience, not many. I will still report the service expecially in regards to pain management services, when appropriate.


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## MMAYCOCK (Apr 16, 2010)

That does not address the technical component- is there anything that states we should not bill for the ASC when using fluro for the 63650?

Thanks


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## rkmcoder (Apr 16, 2010)

(These are my opinions and should not be construed as being the final authority.  Other opinions may vary.)

You may get paid with 77002 in conjunction with 63650.  I am finding some discussion of this on the web (http://www.codapedia.org/topicOpen.cfm?id=920891A6-2D6C-4F0F-AE80C044B6535D1E) and NCCI edits do not bundle it.  I will give it a try for my next claim.

Richard Mann, your pain management coder
rkmcoder@yahoo.com


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