Anesthesia Coding Alert

Question: Blue Cross/Blue Shield and Medicare are denying 77003 as an invalid code when billed with 64640. May I use 77002 for the guidance (C-arm imaging) of the needle?

Georgia Subscriber

Answer: Yes, report 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) rather than CPT 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) to report fluoroscopic needle guidance performed in conjunction with injection code 64640 (Destruction by neurolytic agent; other peripheral nerve or branch).

An article in the June 2008 CPT Assistant directed physicians to report 77003 for injections that are included in the 77003 code descriptor. Additionally, 77003 is to be  used when specifically directed by a CPT parenthetical note such as following 62267.

The article further directed providers to use code 77002 to report fluoroscopic guidance during injection procedures when fluoroscopic guidance is required in the performance of needle placement in areas other than the spine, for pain management injection procedures. 77002 would be reported for fluoroscopic guidance of the destruction of a peripheral nerve or branch.

-- Answers to You Be the Coder and Reader Questions were provided by Scott Groudine, MD, an Albany, N.Y., anesthesiologist; and Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.