Radiology Coding Alert

CPT® 2013 revises the descriptor of 64561 by adding the underlined text: Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) including image guidance, if performed.

"As with a lot of codes now, imaging is included," explains Christy Shanley, CPC, department administrator for the University of California, Irvine.

That means you cannot report codes 76000 (2013 definition: Fluoroscopy [separate procedure], up to 1 hour physician or other qualified health care professional time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) or 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) with 64561, says Michael A. Ferragamo, MD, FACS, clinical assistant professor, University Hospital, State University of New York, Stony Brook.

CCI: The Correct Coding Initiative (CCI) has bundled 64561 with both 76000 and 77002 since 2001. That means that even before the 2013 code definition change, you weren't supposed to report the fluoro codes for guidance in connection with 64561 when submitting claims to payers who apply those edits.

The introduction to the Radiology Section of CPT® includes new wording for Supervision and Interpretation (S&I) direction. It warns coders to check code descriptors and guidelines carefully to see if the surgical procedure under consideration contains imaging guidance. If it does, the imaging can't be separately reported.

However, if there is no mention of imaging guidance in a code or guidelines from the Medicine section of CPT®, radiological S&I may be reported for the portion of the service that requires imaging. Remember that both services require image documentation, and the radiological supervision, interpretation, and report, says Michael A. Granovsky, MD, FACEP, CPC, president of LogixHealth, a medical coding and billing company in Bedford, Mass.