Wiki Imaging for L5, S1, S2, S3 Nerve Blocks

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celcano

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I an new to pain management and would appreciate some insight to this issue.
When we do a L5, S1, S2, S3 Nerve Block, my physician is also charging 77003. If I check the CCI edits, 77002 is bundled, but 77003 is not. I have also see some coders using 77002 OR 77003. Some payers are paying and others are not. I know that imaging is included in some procedure and if 77002 is the correct for this procedure, then it is bundled. Any advice would be greatly appreciated.
 
What procedure code are you billing for the nerve block?
If the procedure is done in the spine you would use 77003 (see descriptions of 77003 and 77002 below). However, 77003 has quite a few procedures that it is bundled with per CPT guidelines. Keep in mind that CPT guidelines are different from NCCI edits; you must always check both as well as insurance medical policies or LCD/NCD.
example:
#1. 64483 with 77003. There is no NCCI edit bundling for 64483 and 77003 but the CPT guidelines do not allow for separate billing.
#2. 62311 with 77003. There is no NCCI edit bundling for 62310 or 62311 with 77003 and the CPT guidelines allow for billing together, but CMS bundles them.

According to the CPT®, code 77003 is per spinal region (cervical, thoracic, lumbar, or sacral). Do not bill per level. Modifier 59 Distinct procedural service can be used to identify a separate guidance/localization procedure performed in different spinal regions.


Use 77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) for fluoroscopic guidance for needle placement for non-spinal procedures. An example would be when a physician performs a major joint injection for a shoulder, knee or hip.
 
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