# 64450 and 77003 - My physician has billed 64450



## celcano (Sep 18, 2015)

My physician has billed 64450 x 4 for a L5, S1, S2 and S3 nerve block.  He wants to bill fluoro with 77003.  When I check the CCI edits, I see where 77002 is bundled, but not 77003.  He told me that 77003 was the correct fluoro code for SJI as the sacrum is part of the spine.  Is it OK to bill 77003?

Thank you for your assistance.


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## mcastellanos (Sep 18, 2015)

Was injection for epidural or anesthetic?


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## celcano (Sep 19, 2015)

I apologize.  I am relatively new to pain management.  The block is for a treatment vs a temporary block for surgery.   Does that clarify this?


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## dwaldman (Sep 22, 2015)

NCCI did not recognize when they created the edit for 64450 and 77002 that lateral branch SI joint nerve blocks are being performed with the code combination of 64450 77003. You could write NCCI and ask if it is appropriate to bill.

AMA used have certain codes such as 64520 to be billed with 77002 in a prior AMA CPT Assistant article. The more recent publication of this code they switched to suggesting 77003. 

Currently, 77003 is recognized by the AMA with an epidural, epidural blood patch, lumbar puncture are the procedures that come to mind. I believe it appears for the procedure in question that you could assume that the AMA would agree that 77003 would be appropriate but without sending a question to them, this would be assumption.


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## celcano (Oct 2, 2015)

Thank you.  This is very helpful.


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