Radiology Coding Alert

Question: The CPT^® book says we shouldn’t use 77003 with 64483 or 64493, but CCI says we can override that with a modifier. Is that correct?

Codify Subscriber

Answer: You may override the related edits with a modifier when the fluoroscopic guidance is unrelated to the lumbar or sacral injection codes in your question.

The Correct Coding Initiative (CCI) edits bundle 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, or subarachnoid]) into the following codes:

• 64483, Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level
• 64493, Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level.

The edits make sense because both 64483 and 64493 include fluoroscopic guidance in their descriptors. Additionally, parenthetical notes with the codes in CPT^® state that fluoroscopic guidance and localization are inclusive components of 64479-64484 and 64490-64495, and the codes in question fall in these ranges.

The CCI edits have a modifier indicator of 1, which means you may use a modifier to override the edits under appropriate circumstances. For instance, an appropriate circumstance could involve the bundled service being performed at a separate session during a distinct procedure. CMS offers more information on overriding edits in the “Modifier 59 Article” available in the Downloads section at www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html.