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) [...]