Forum - Questions & Answers

May 7th, 2009 - luannw7     18 

CPT 63650

63650-percutaneous implantation of a neurostimulator electrode array, epidural. Does this procedure include a floroscopy 77003? We have a pain management physician who insists that it needs to be added. (not bundled in procedure) I checked the CCI edits and a modifier -59 can be used; but I do not beleive it is appropriate. Some guidance, anyone?
Thanks.
LuAnn

May 7th, 2009 - nmaguire   2,606 

Fluoroscopy

A general rule of thumb is if fluoroscopy is always performed as a part of the radiological imaging study, fluoroscopy is included in the radiological procedure code. If on the CCI edits, then fluoroscopy is integral to code 63650.

May 11th, 2009 - marlap 10 

fluoroscopy

We charge the 77002 with a 26 modifier because we do spinal cord stimulators as an outpatient at the hospital. Medicare will pay as a separate charge but Blue Cross and Blue Shield does not. The ASA has published excellent guidance on the use of code 77003 that I have used several times to appeal denials for other types of injections.

May 12th, 2009 - luannw7     18 

CPT 63650

Thank you. Do you have the website to get the published guidance?

May 14th, 2009 - marlap 10 

Link to Memo about Fluoro guidance

http://www.asahq.org/news/031907Fluoroupdate.pdf

I have used this memo as a reference several times to appeal unfavorable decisions about 77003 being inclusive with a variety of steroidal injections for different insurance companies. Basically the position is the code reads that the contrast is bundled and not the use of fluoroscopic guidance. Hope this helps.

May 14th, 2009 - luannw7     18 

CPT 63650

Thank you for the documentation. CPT code 63650 is not listed on the documentation and it is not listed as a can't do in the CPT book either; but it comes up in our billing software needing a modifier (I am assuming the -59) I checked with the CCI edits (hoping the edit was a mistake in the billing software, but it does say a modifier is necessary.) I am not comfortable with just slapping on a modifier, it needs to be a distinct, procedural service.

May 14th, 2009 - marlap 10 

fluoroscopy

We use the 77002 instead of the 77003 code because we are using the flouro guidance for needle placement. The description for 77003 focuses more on the guidance for diagnostic or therapeutic injection procedures and then goes on to list epidural, transforaminal, etc. The coding guidance we received from the company that supplies our leads and battery packs recommended the 77002 code.



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