Anesthesia Coding Alert

Question: I’m having trouble understanding the differences between fluoroscopic codes +77002 and +77003. Is the difference based on the treatment site location? Is +77003 only for the spine and +77002 is for all other body areas? Or does it come down to whether the provider injected contrast?

Indiana Subscriber

Answer: Both codes that you’re attempting to learn more about represent fluoroscopic guidance only. They both also are add-on codes, meaning that you can only report them in conjunction with other specified services.

Code +77002 (Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure)) represents needle placement but is not specific to a particular body area. This code does not include the injection procedure. You’ll typically report +77002 with major joint injections such as 20610 (Arthrocentesis, aspiration and/or injection, major joint or bursa [eg, shoulder, hip, knee, subacromial bursa]; without ultrasound guidance) or other peripheral injections.

Code +77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (List separately in addition to code for primary procedure)) is used only for the spine and paraspinous area; the associated work includes localization of the needle or catheter.

Pay attention: CPT^® guidelines list the specific codes that you’re allowed to report with either +77002 or +77003. Specific codes you cannot report with either +77002 or +77003 are also noted. For example, guidelines state that the work of +77002 is included in all arthrography radiological supervision and interpretation codes, so you should not add it to those claims.

>Do not report +77003 with procedures with descriptors that specify no guidance is used such as 62320 (Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance) or those with descriptors that already include guidance, such as 62321 (Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy or CT)).