# Fluro and modifier 59



## MLITE2113 (Jul 13, 2015)

Hey all

I am confused with regards to billing for fluro for say a Transforaminal ESI and adding the 59 modifier to code 77003. 
I say we cannot bill the fluro separately (77003) with a 64483 because per the CPT book it says do not report 77002, 77003 in conjunction with 10030,22586,27096,64479-64484, 64490-64495, 64633-64636, 0195T, 0196T, 0309T. 
The problem I am having is when you put the two codes into a CCI checker (we use medassets or codecorrect) It says it is payable with modifier 59 and my employer wants to bill it with everything. I say no because of what it says in the CPT book... Wouldnt we need separate documentation if we are going to be using a 59 everytime?!? I mean the provider can't do a TFESI without fluro. 
Any links or documentation on this would be very helpful and if the employer is right I can live with that too I just need the clarification!


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## espressoguy (Jul 13, 2015)

Code Correct will tell you that a modifier can be used *IF APPROPRIATE*.

Since 64483 includes imaging guidance, it is not appropriate to also bill for the imaging guidance separately.


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## dwaldman (Jul 14, 2015)

You can not report 77003 with 64479-64484, this is not about NCCI, it is the fact the AMA updated the code descriptor in 2011 and states that CPT 77003 can not be separately be reported.

Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); 

Below is from AMA CPT Change 2011

Similarly, in the CPT 2011 code set, more changes have been made in the Nervous System section including: (1) *revisions to the Paravertebral Spinal Nerves and Branches notes; (2) revisions to codes 64479, 64480, 64483, and 64484 to include fluoroscopic and CT guidance with transforaminal epidural injection services; *and (3) addition of several parenthetical notes following codes 64479, 64480, 64483, and 64484 to instruct appropriate use of these services.

Code 64479 is reported for injections at the cervical or thoracic level using fluoroscopic or CT guidance. A cross-reference note has been added following 64479 to direct users to report 0228T for transforaminal epidural injection under ultrasound guidance.

Add-on code 64480 is reported for any additional levels treated at the cervical or thoracic region using fluoroscopic or CT guidance. Two cross-reference notes have been added following code 64480 to direct users to report (1) 0229T for transforaminal epidural injection under ultrasound guidance and (2) 64479 for transforaminal epidural injection at the T12-L1 level.

Code 64483 is reported for injections at the lumbar or sacral level using fluoroscopic or CT guidance. A cross-reference note has been added following 64483 to direct users to report 0230T for transforaminal epidural injection under ultrasound guidance.

Add-on code 64484 is reported for any additional levels treated at the lumbar or sacral region using fluoroscopic or CT guidance. One cross-reference note and one instructional note has been added following 64484 to direct user to (1) report 0231T for transforaminal epidural injection under ultrasound guidance and (2) instruct that bilateral procedures should be reported using modifier 50. Codes 64479 - 64484 are unilateral procedures.


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## MLITE2113 (Jul 14, 2015)

Thank you both for your input... Now I have proof along with my CPT book


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