# 2013 Fluoro bundled in LESI & CESI ?



## Licorice5 (Jan 14, 2013)

My boss is adamant that fluoroscopy is now bundled in LESI"s and CESI's but I can't find anywhere that states this change. 
Is this correct? If so, do you have a link or article where it's stated?
Thanks.


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## aaron.lucas (Jan 14, 2013)

No, 62310-62319 don't include fluoro for this year.  I think what your boss is seeing is in the code description:  "includes contrast for localization".  That just means they can't bill separately for the contrast injection, nothing more than that.  The list of codes that include fluoro are in the Radiology section after 77003.  Look for the green text.  Hope that helps!


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## Licorice5 (Jan 14, 2013)

I totally agree with what you've said and I tried again to explain that but she is adamant that fluoro is now bundled. She said she received the AMA CPT update and that's what was stated and since they're the ones that put out the CPT books they should know.

There's just no way a change like this would have happened and no one mention it on this forum nor can I find anything when I do a google search.


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## aaron.lucas (Jan 15, 2013)

Have you seen this update?  If not I would ask her to show it to you, as she may be misreading it.  Other than that not sure how else you can convince her beyond billing it and having her see it get approved?  Maybe if she gets paid for it she'll realize you're right?  Sorry I can't be more help.


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## Michele Hannon (Jan 15, 2013)

This might be a helpful link to the 2013 CPT changes for anesthesia/pain management.
http://www.anesthesiallc.com/easyblog/entry/2013-cpt-coding-changes-pain-management-and-anesthesia


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## marvelh (Jan 15, 2013)

Show her the Spine and Spinal Cord: Injection, Drainage or Aspiration section guidelines in the 2013 CPT codebook:

"... Fluoroscopy (for localization) may be used in the placement of injections reported with 6210-62319, but is not required.  If used, fluoroscopy should be reported with 77003..."


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## Licorice5 (Jan 16, 2013)

I showed her that section and she still says no you go to the cpt update and then to radiology. I tried explaining that it's just the contrast they are talking about but she says no it's fluoro. So I went to the radiology section and like you guys I read it's coded. She said the only thing she can do to prove it to me is to bill it and then show me the denial and then she has to write it off. 
I just let it go because I'm tired of arguing about it. I've asked a friend if she sees a payment come in at their practice and fluoro is paid if she would let me know or send me a copy so I can show her.
The problem is this is something we do several of each day so while fluoro isn't a lot of money, it's still money they are losing out on.
Thanks for all your help.


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## dwaldman (Jan 16, 2013)

77003  
Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid)  

In 2010, CPT codes for facet injections (64470-64476) were deleted and replaced with CPT 64490-64495. When this change took place, CPT 77003 was updated to remove facet joint injection from the descriptor of 77003.

In  2012, CPT for an sacroilliac joint injection was revised to include fluoroscopy guidance, 77003 was also updated to remove sacroilliac joint injection from the code descriptor.

In 2012, CPT for destruction of paravertebral facet joint nerves was revised and 77003 was also updated to remove reference to this procedure.

In each of the years, that these updates took place, AMA CPT Changes documented that the descriptor for 77003 was updated and no longer could it be reported in conjunction with the procedures they included and required fluoroscopy with. If you review 2010-2013, AMA CPT Changes, you will find, that intralaminar/caudal epdiurals and subarachnoid injections are still reportable with 77003. 

 "Code 77003 is no longer reported separately when reporting the transforaminal epidural injection codes; thus, the term "transforaminal epidural" was deleted from the 77003 code descriptor."

Above is from AMA CPT Assistant Feb 2011, as mention eariler when the AMA decides to include fluoroscopy in pain management procedures, they also revise the descriptor to 77003. The current descriptor for 77003 gives examples of procedures that it is intended to be currently reported with ie epidural or subarachnoid. 

If there was a change in the reporting in 2013, this would appear in AMA CPT Changes 2013. There is no reference in AMA CPT Changes of this inclusion.


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