Pain Management Coding Alert

Question: Are we able to bill for fluoroscopic guidance/placement separately for intercostal nerve blocks?

Arizona Subscriber

Answer: The codes you’re considering are 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]), 64420 (Injection, anesthetic agent; intercostal nerve, single), and 64421 (…intercostal nerves, multiple, regional block).

Current CCI edits list 77002 as a Column 2 code for both 64420 and 64421.Because your provider is using the guidance for the injection, you cannot report both services.

Different scenario: If your physician uses the fluoroscopic guidance with a different procedure, you might be able to bill for both. For example, if the image guidance was used for a separate shoulder injection instead of for the nerve block, you could report the image guidance with the appropriate modifier to bypass the bundling edit.