Anesthesia Coding Alert

Question: Our payer denies CPT 77003 when we bill it with CPT 64640 , stating that the codes are mutually exclusive. Can we instead use 77002 for the guidance (C-arm imaging) of the needle?

Georgia Subscriber

Answer: Yes, 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) often is the compliant CPT code to report in conjunction with 64640 (Destruction by neurolytic agent; other peripheral nerve or branch). Here's why:

• Code 77002 describes fluoroscopic guidance during pain management injection procedures when your physician requires guidance for needle placement in areas other than the spine. Submitting 64640 tips off the payer that you're not reporting a spinal injection.

• Code 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve, or sacroiliac joint], including neurolytic agent destruction) is specifically for fluoroscopic guidance of the procedures included in the descriptor. The injection represented by 64640 falls outside those parameters.

If your provider performed the destruction procedure in a facility place of service (such as an Ambulatory Surgery Center [ASC] or hospital outpatient department), append modifier 26 (Professional component) to report your provider's professional component of the fluoro-scopic needle guidance. Also check with your local payer about specific guidelines for these procedures. The latest Correct Coding Initiative (CCI) edits don't bundle 77002 and 64640 as a comprehensive/component pair or as mutually exclusive, but check whether your local payer has different bundling policies.