# 62311 and 77003



## jessieindiego (Feb 20, 2008)

My office has been getting numerous denials from blue shield stating that per the ama 77003 is bundled into 62310, 62311...etc. underneath the code is does state that the contrast is a part of, but no where does it state that the flouro is. i have have been searching for proof to send back to them but always come up short...if i could get some help i would greatly appreciate it...i have been searching the ama site but nothing comes up for me....


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## missyah20 (Feb 21, 2008)

I am having the same problem.  Medicare is also denying 77003.  I have not been able to find any thing on Medicare's website to help me.  I did find some information on the ASA website if you search under fluoroscopic guidance.  I have been using that to help with me appeals.  Hope that helps. 

Their website is www.ASAhq.org.


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## kevbshields (Feb 21, 2008)

You will continue to receive denials for this code pair.  62310-62319 include any fluoro guidance, contrast or related studies used in the administration of these services.  While the code descriptor states "with or without contrast," it's inferential that fluoro falls into that category.

My recommendation would be assure your facilities are only sending the injection service code out on claims.  Any fluoroscopy billed in conjunction is putting the practice at risk for audits or sanctions as this is universally considered a bundled procedure.

Good luck.


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## mbort (Feb 21, 2008)

After seeing Kevs response, I had look into this because I have been using fluoro with those codes forever. 

My research found the following: 
Code-Specific Reference Information      

 AMA CPT® Assistant References   
Instructions      

 Excludes fluoroscopic guidance and localization unless a formal contrast study is performed (77003)  



Injection of contrast during fluoroscopic guidance and localization is an inclusive component of codes 62263-62264, 62270-62273, 62280-62282, 62310-62319, 0027T. Fluoroscopic guidance and localization is reported by code 77003, unless a formal contrast study (myelography, epidurography, or arthrography) is performed, in which case the use of fluoroscopy is included in the supervision and interpretation codes.


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## elenax (Feb 22, 2008)

*Fluroscopy*

The CPT Expert 2008 under the code *77003* there is a note that indicates:  *" Do not report *with (0027T, 22526-22527, 62263-62254, 62270-62282, *62310-62319*)"


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## mbort (Feb 22, 2008)

I guess now I'm confused again, in my CPT 2008 Professional Edition, under the code it states 

Injection of contrast during fluoroscopic guidance and localization (77003) is included in 22526, 22527, 62263, 62264, 62270-62282, 62310-62319, 0027T).

Under the instructions in my Encoder it has the following which shows to seperate contradictory statements:

Instructions - 77003 

Excludes neurolytic agent destruction (64600-64680)  
Excludes injection and needle/catheter placement, epidural/subarachnoid (62270-62282, 62310-62319)  Excludes injection, paravertebral facet joint (64470-64476)  
Excludes transforaminal epidural needle placement/injection (64479-64484)  
Excludes sacroiliac joint arthrography (27096, 73542)  
Do not report with (0027T, 22526-22527, 62263-62264, 62270-62282, 62310-62319)  

Anybody else have any thoughts/supporting documentation???


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## mbort (Feb 22, 2008)

Here is more documentation.  Specifically page 9

http://www.gehealthcare.com/usen/community/reimbursement/docs/FluoroPainMgmt.pdf

I'm still looking for something other than the CPT expert that validates not billing them together (nothing personal but I figure if the AAPC does not back up the CPT expert, then the info contained therein is not substantiated).


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## kevbshields (Feb 22, 2008)

AMA sets the standards for CPT coding, not AAPC.

I know that most Federal payers have edits that kick this combination out when billed by the same provider, same DOS.  As I know it, this has always been a standard, since before 77003 we had 76005--which was also excluded as they _are not formal studies, simply guidance procedures, included within the code descriptor.

No offense taken, but I would never advocate the inclusion of both codes on a bill--this is a clear violation of AMA coding standards as stated within the manual.

Good luck._


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## jessieindiego (Feb 22, 2008)

This is the website i looked at after receving numerous denials. What I am trying to get at is the contrast in bundled not the guidance...i have only gotten conflicting info from blueshield...no other payer. It has been done this way for years with the 76005 and now the 77003, there is always going to be someone who reads the info just a bit worng and sets the whole thing off course.


http://www.asahq.org/news/031907Fluoroupdate.pdf

Page 3 2nd paragraph.


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## mbort (Feb 25, 2008)

Thank you!!!!


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## softwillow (Feb 25, 2008)

In my Coding Expert book for 77003-in the ASC Payment Indicator it shows as N1- which is: "Packaged procedure/Item; no separate payment made."  So, although it appears to not be bundled with the code 62311- it looks to be non-covered if in an ASC setting.  (


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## softwillow (Feb 25, 2008)

*CPT Expert and CPT Pro*

The CPT Expert and CPT Pro give conflicting information regarding billing 77003 with 62311. I'm not sure if it's a typo or what- but I'm opting for listening to CPT Pro.


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## kevbshields (Feb 26, 2008)

*Devil's Advocate*

If contrast is included in the code descriptor, then what is left to report by using 77003?


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## mbort (Feb 26, 2008)

the fluoroscopic guidance and localization of needle placement


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## kevbshields (Feb 27, 2008)

Are your providers keeping hard copies of the needle placements/localization (e.g., films)?


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## mbort (Feb 28, 2008)

Yes, mine do, I thought it was standard but I could be wrong on that.  Hard copies are printed and kept within the facility as a part of the patients' medical record.


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## kevbshields (Feb 28, 2008)

I opine with the payers on this topic:  for the pro fees, it is inherent to the 60,000 series code.  I believe the facility _may_ have an additional charge (dependent upon the IP/OP status) based on if those films are actually maintained as permanent images, but see no clear need for the physicians to report 77003 as if it were an RS&I code . . .


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## marvelh (Feb 29, 2008)

The use of fluoroscopy for needle placement / guidance is NOT including into the 62310 - 62319 code range.  There is an error in the Ingenix 2008 CPT book that is not in the official AMA CPT book.  I sometimes wonder since UnitedHealth Care purchased Ingenix if we are going to see more of these types of "opps!"

The American Society for Interventional Pain Practitioners has written a very strongly worded letter to BCBS for incorrectly bundling the fluoroscopic guidance into the epidural codes.  Likewise the stance of the ASA in their position statement in October 2007.

When the epidural codes were created in 2000, the RVU for use of fluoroscopy was NOT included in the RVU for the epidural injection procedures.  There were and still are epidural injections performed without radiologic guidance, hence the RUC committee didn't want to allow higher RVU to providers that didn't use the fluoroscopic guidance.  When we got the new 77003 code in 2007, the ONLY thing that changed was the CPT code number.  The renumbering was done to "group" the needle guidance codes together in the radiologic section for easier computerized mapping.

Providers using fluoroscopic guidance can or can not inject contrast during the needle guidance.  The point of the parenthetical note is that the physician cannot report the injection of the contrast as a separate procedure.

Appeal ALL denials from payers that bundle the fluoroscopy into the epidural injection for the provider services.

The outpatient hospital and ASC facility billing has always included the fluoroscopic guidance into the grouper payment and now the APC.  The technical component is not separately reimbursed but most certainly the professional component should be.


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## dav4code (Mar 22, 2011)

marvelh said:


> The use of fluoroscopy for needle placement / guidance is NOT including into the 62310 - 62319 code range.  There is an error in the Ingenix 2008 CPT book that is not in the official AMA CPT book.  I sometimes wonder since UnitedHealth Care purchased Ingenix if we are going to see more of these types of "opps!"
> ...



Did UnitedHealth Care buy the AMA!@#?

"The November 2010 issue of CPT Assistant caused major consternation among pain physicians. In answer to a question regarding the reporting of fluoroscopic guidance, the publication stated that fluoroscopic guidance was bundled with the translaminar epidural injections, CPT 62310-62319, and was not separately payable.

The inclusion of fluoroscopic guidance in the payment for 62310-62319 appeared more than revolutionary – it seemed wrong. ASA followed up with CPT Assistant staff and quickly obtained a formal correction."

As if we needed more confusion!


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## marvelh (Mar 23, 2011)

The CPT Assistant published a "retraction" / correction in the January 2011 issue regarding this erroneous article.  Also the correction is available as a PDF file on the AMA letterhead for appealing denials at - http://tinyurl.com/AMACPTAssistantNov10errata


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