Wiki question regarding fluro

[MAMILLER]

I have a pain doc who uses codes 77002 and 77003 with most of his procedures ie....64470-64479 and 64480 and 64483 among others. I see that 77002 and 77003 have N1 indicators; does that mean I should not bill these fluro codes even with a TC modifier?:

 

[ASC CODER]

since it does have a payment indicator of N1 that means Medicare wont pay for it. However other payers might. So in my opinion you would code 77002 and 77003 with TC across the board knowing that your Medicare will not pay. They can track the procedure for future

 

[CatLaw]

Always try billing for those regardless. My office bills for 77003 and we get paid by many carriers. I keep a list of who pays and who doesn't for certain procedures just to keep track. You never know until you bill.

 

[MAMILLER]

Thanks so much for the info. This helps.
Have a great day!!!

 

[mbort]

if you are going to bill the fluoro to Medicare, I might suggest that you add the GY modifier:

GY — Statutorily excluded (A&P)
If your facility is trying to bill all payors with the same codes in the same manner — since some payors other than Medicare may get mad if you bill them for something you don't bill to Medicare — it can be challenging since some payors (especially Medicare) do not cover all billed codes for procedures performed. When billing a CPT code to a payor you know is not covered by that payor (for example, billing 77003 (fluoroscopy) to Medicare), append the -GY modifier. This lets the payor know you that you are aware that they don't cover the service and you expect a denial for that charge. This code would be billed to Medicare as 77003-GY-TC.

There is verbiage change for the -GY modifier that became effective July 1, 2007. Prior to July 2007, the verbiage stated that “the –GY modifier is to be used when providers need to indicate that the item or service they are billing is statutorily non-covered or is not a Medicare benefit.” As of July 1, 2007 the verbiage states that “the –GY modifier is to be used when physicians, practitioners or suppliers who want to indicate an item or service is statutorily excluded, does not meet the definition of any Medicare benefit or mon-Medicare insurers, is not a contract benefit.”

http://www.beckersasc.com/news-anal...-to-asc-and-physician-practice-modifiers.html
(some of the info contained is outdated now)

 

[MAMILLER]

Thanks Mary, this is great advise! I appreciate it!