# Intercostal Nerve Block and Fluoro Guidance



## celcano (Mar 28, 2016)

My physician did some intercostal nerve blocks and billed 64421 and 77003.  My coding software says that "any radiologic guidance is separately reported."  Are intercostal nerves considered spinal nerves?  If so, then 77003 is correct and there are no bundling edits in place.  If not, then 77002 hits a CCI edit.  

Thank you for any assistance.


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## mhstrauss (Mar 28, 2016)

celcano said:


> My physician did some intercostal nerve blocks and billed 64421 and 77003.  My coding software says that "any radiologic guidance is separately reported."  Are intercostal nerves considered spinal nerves?  If so, then 77003 is correct and there are no bundling edits in place.  If not, then 77002 hits a CCI edit.
> 
> Thank you for any assistance.



I don't have any references, and I don't think I've ever read anything specific about which nerves would fall under 77002/77003, but I don't think I would consider the intercostals to be spinal. Just my $0.02.


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## dwaldman (Mar 28, 2016)

AMA CPT Assistant from 2008 states that 64400-64450 would correspond with 77002, and it is known that CMS NCCI bundle CPT 77002 with the majority of these codes. CPT 77003 would not be used in conjunction with an intercostal block.


June 2008 page 8

Coding Clarification:Fluoroscopy-76000, 76001, 77001, 77002, and 77003


Code 77002

Code 77002, 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. Codes 76000 and 76001 differ in that the descriptors do not specifically identify fluoroscopic guidance for a procedure involving needle or device placement. The organ or anatomic site is not specified for use of code 77002; therefore, fluoroscopic guidance as described by code 77002 may be performed in support of a procedure described, for example, by codes 20553, 20555, 20610, 51100-51102, 60100, and 62287, to name but a few. Code 62287 is included in the 77002 list because it is a spinal procedure and not a spinal injection. 

To differentiate, code 77002 rather than code 77003 should be reported to identify the fluoroscopic guidance performed in conjunction with injection codes 64400- 64450, 64505-64530, 64600-64620, or 64630-64680, because this code more accurately describes the fluoroscopic guidance procedure performed for the anatomy involved. (ie, these types of injections are not included in the list in the 77003 code descriptor). 

Code 77002 should not be reported separately with any radiographic arthrography (code 70332, 73040, 73085, 73115, 73525, 73580, or 73615) with the exception of computed tomography (CT) and magnetic resonance (MR) arthrography.


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