I am having a hard time understanding the new changes for 2015 for CPT code 62311 and 77003. One version of a CPT book is telling me to also bill 77003. When I turn to 77003 it states that it can not be billed with 62311. Everything that I have read points to that they can not be billed together. I have called our local MAC and have asked if they can be billed together and have been told yes. I am so confused! Please help !!!
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Wiki 62311 for 2015
- Thread starter HOWRU2DAY
- Start date
mhstrauss
True Blue
I have the AMA's Professional Edition CPT...I'm looking at 62311 now, and do not see any guidance that 77003 cannot be billed with 62311. Which version of the book do you have? And what exactly does it say? I wasn't aware there were any changes to this codeset for 2015.
mitchellde
True Blue
77003 does not state do not code with 62311. It states that the injection of contrast is included with 62311, there is a list of codes that you cannot report with 77003 but the 62311 is not among those listed. In addition this was not a 2015 revision nor have either of these codes been revised.
benaxixon
Guest
77003 is included with 62310-62311 per the AMA cpt book, the description is under 77003..
mitchellde
True Blue
That is not what the CPT description states. Read it carefully.
It states " injection of contrast during fluoroscopic localization and guidance [77003] is included in ...... 62310-62319.
It does NOT say fluoroscopic localization and guidance [77003] is included in .... 62310-62319.
Melissa Harris CPC
Expert
The terminology is confusing but for 62310 and 62311 you can bill fluoroscopy (77003).
Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management
Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management
Zina
Guest
CMS must have made the decision to include 77003 in 62311 and 62310 after the book was published, they are not paying any of ours. Per Part B insider, they raised the RVU to allow for including the 77003 in the 62310-62311.
dclark7
True Blue
Just checked the 1/1/15 NCCI edit list on CMS, 77003 is not on the NCCI edit list with 62310 or 62311, only 77001 and 77002 which both allow for a modifier.
ptanksley51
New
pst
per cpt coding book the description for 62311 reads "includes contrast for localization when performed" also 77003 says it is included in 62310-62319 which means all codes from 62310 through 62319 hope this helps
per cpt coding book the description for 62311 reads "includes contrast for localization when performed" also 77003 says it is included in 62310-62319 which means all codes from 62310 through 62319 hope this helps
ahachmann
Guest
62311 and 77003
The way I am reading the CPT book is the "contrast" is included with the flouroscopy and cannot be billed separately but we can still bill the 77003 with the 62310-62319
Unless stated otherwise in the descriptive part of the code; we should be able to use it.
We were told in a Webinar ( not AAPC) to stop using the 77003 with these codes and I don't think that was correct.
Any thoughts on this is apprciated..
The way I am reading the CPT book is the "contrast" is included with the flouroscopy and cannot be billed separately but we can still bill the 77003 with the 62310-62319
Unless stated otherwise in the descriptive part of the code; we should be able to use it.
We were told in a Webinar ( not AAPC) to stop using the 77003 with these codes and I don't think that was correct.
Any thoughts on this is apprciated..
mitchellde
True Blue
It is the injection of the contrast that cannot be billed. the 62310-62319 can be billed with the 77003. The wording is correct and not confusing. The payer may be all confused but the book is clear. You just cannot bill for the injection of the contrast as an additional charge. I would appeal the denials.
AC32333
Contributor
See the November 13, 2014, Federal Register Doc # 2014-26183, pages 67547-68010, 67578-67579).
?After considering comments received, we are finalizing CPT codes 62310, 62311, 62318, and 62319 as potentially misvalued, finalizing the proposed RVUs for these services, and prohibiting separate billing of image guidance in conjunction with these services.?
The rationale was that to allow the use of CPT 77003 would overestimate the resources used in furnishing the overall service.
?After considering comments received, we are finalizing CPT codes 62310, 62311, 62318, and 62319 as potentially misvalued, finalizing the proposed RVUs for these services, and prohibiting separate billing of image guidance in conjunction with these services.?
The rationale was that to allow the use of CPT 77003 would overestimate the resources used in furnishing the overall service.
KMCFADYEN
Expert
CMS is bundling 77003 with 62310-62319 so you do not bill 77003 or contrast to CMS. Most other payers allow it because per AMA CPT, it is not bundled.
RSammons
New
I do remember this being the case for physicians, however I was able to code/charge 77003 with epidural injections in facility (62310, et al) & now it is a NCCI edit. Did something change with the April 2015 OPPS update?
mlelkins
New
I am also now getting NCCI edit denials. I am following this for any additional info. Thanks.
mhstrauss
True Blue
We are also getting denials now for 77003 when billed with 62310/1. This code combo is on the NCCI Additions effective April 2015. I don't think we've gotten any denials from commercial payers yet. I wouldn't be surprised if the AMA updates the CPT codes to reflect the same change in the future, considering the same thing was done with trans-ESI's and RFA's in the last few years. 
pbradshaw
New
77003 Bundled with Epidural injections
It does appear that Effective April 1, 2015, 77003 is bundled with 62310 & 62311 but does allow for a modifier, according to the NCCI edit. Of course we didn't know this until we got denials from Medicare on the 77003. Medicare tells us that 77003 now requires a modifier when billing with these injections. I think it's funny that we didn't get any notice or addendum from AMA or CMS regarding the changes.
It does appear that Effective April 1, 2015, 77003 is bundled with 62310 & 62311 but does allow for a modifier, according to the NCCI edit. Of course we didn't know this until we got denials from Medicare on the 77003. Medicare tells us that 77003 now requires a modifier when billing with these injections. I think it's funny that we didn't get any notice or addendum from AMA or CMS regarding the changes.
Zina
Guest
The problem with the 77003 has nothing to do with the CPT book. It is an insurance company policy issue.....if you are getting denials, as we are, the 77003 is no longer paid separately from 62311 etc. Our medicare carrier has raised the RVU slightly for the 62311 etc and is excluding payment on the 77003. Our medicare carrier is Novitas and Horizon BCBSNJ, among others, has followed suit.
janerisr
New
77003 with 62311
Hello,
There was an NCCI edit added April 1 which became retroactive to January 1, 2015 that conflicts with the 2015 CPT guidelines stating fluoroscopic guidance is not included in codes 62310 and 62311 and, if utilized, should be reported with 77003.
In the MPFS final rule, CMS 1612-FC, CMS states: "After considering comments received, we are finalizing CPT codes 62310, 62311, 62318, and 62319 as potentially misvalued, finalizing the proposed RVUs[relative value units] for these services, and prohibiting separate billing of image guidance in conjunction with these services".
In a nutshell, CMS believes that the new value of these codes are enough to include the guidance portion and should not be billed separately. There are times that CMS rules conflict with AMA/CPT rules so always check with your payer as which rule they follow since commercial payers may still pay it.
Hello,
There was an NCCI edit added April 1 which became retroactive to January 1, 2015 that conflicts with the 2015 CPT guidelines stating fluoroscopic guidance is not included in codes 62310 and 62311 and, if utilized, should be reported with 77003.
In the MPFS final rule, CMS 1612-FC, CMS states: "After considering comments received, we are finalizing CPT codes 62310, 62311, 62318, and 62319 as potentially misvalued, finalizing the proposed RVUs[relative value units] for these services, and prohibiting separate billing of image guidance in conjunction with these services".
In a nutshell, CMS believes that the new value of these codes are enough to include the guidance portion and should not be billed separately. There are times that CMS rules conflict with AMA/CPT rules so always check with your payer as which rule they follow since commercial payers may still pay it.