Radiology Coding Alert

Know when guidance codes don’t need to be reported.

Read on to get answers to three image guidance frequently asked questions (FAQs).

How do the Fluoroscopic Guidance Codes Differ?

The Radiology section of the CPT^® code set separates image guidance codes by the equipment type. The fluoroscopic guidance code subsection includes the following three add-on codes:

• +77001 (Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position) (List separately in addition to code for primary procedure))
• +77002 (Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure))
• +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))

The difference between each of these add-on codes is with what procedure the guidance is used. “Add-on code +77001 can only be used with central venous access placement per the descriptor. So, one of the most common uses of +77001 is when a tunneled central venous catheter with port is placed using fluoroscopy,” says Maia Karpenske, CPC, CIRCC, interventional radiology coder at Tennessee Interventional Imaging Associates in Chattanooga, Tennessee.

You can only use +77003 with spinal procedures according to the code descriptor. Procedures involving the spine that require fluoroscopic guidance may include an injection procedure for myelography, coded to 62284 (Injection procedure for myelography and/or computed tomography, lumbar), or chemotherapy injections like 96450 (Chemotherapy administration, into CNS (eg, intrathecal), requiring and including spinal puncture).

However, if the provider uses fluoroscopic guidance to perform a biopsy, aspiration, injection, or another procedure elsewhere on the body, then you’ll assign +77002.

Remember: According to CPT^® guidelines, you must report a primary procedure code in order to correctly report the fluoroscopic guidance add-on code.

Parenthetical notes: This subsection of codes is loaded with parenthetical notes that provide instructions on how to report the codes correctly. Just under the subsection title is a note that explains to not report these guidance codes for services that include fluoroscopic guidance in the descriptor.

For example, a service that features fluoroscopic guidance in the descriptor is 33957 (Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition peripheral (arterial and/ or venous) cannula(e), percutaneous, birth through 5 years of age (includes fluoroscopic guidance, when performed)). If the provider performed this service and used fluoroscopic guidance, then you’d assign only 33957 to report the service. You’d also report 33957 for this procedure if the service was performed without fluoroscopic guidance.

Codes +77001 and +77003 feature parenthetical notes that instruct you to not report the add-on codes with certain procedure codes. On the other hand, +77002 and +77003 also include notes that show you what codes can be reported with each code.

Can I Bill Multiple Procedures With CT Guidance?

The answer to this question is tricky because it depends on the procedures being performed with computed tomography (CT) guidance. Much like the fluoroscopic guidance codes, you can’t report a separate CT guidance code if the guidance is bundled into the service being performed.

So, here’s a scenario to help you determine whether you can bill CT guidance separately. First, familiarize yourself with the CT guidance codes listed in the CPT^® code set:

• 77011 (Computed tomography guidance for stereotactic localization)
• 77012 (Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation)
• 77013 (Computed tomography guidance for, and monitoring of, parenchymal tissue ablation)
• 77014 (Computed tomography guidance for placement of radiation therapy fields)

Next, examine the following scenario to see where a separate CT guidance code is needed.

Scenario: A provider performs a lung biopsy with CT guidance. Later during the same encounter, the provider performs a CT-guided biopsy in the right thigh muscle.

In this scenario, you’ll report 32408 (Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed) to report the CT-guided lung biopsy since the image guidance is included in the code. However, you’ll need a guidance code for the CT-guided thigh muscle biopsy since 20206 (Biopsy, muscle, percutaneous needle) doesn’t include the guidance.

“The CT guidance is not bundled into the thigh biopsy code, but it will need to be modified. We can do this because it meets the criteria of a separate site,” Karpenske says. Check your individual payer preferences to see which modifier(s) to use to report the multiple procedures correctly.