Radiology Question for the Week of May 9, 2016

Question:

Question:

My doctor uses fluoro guidance when he performs lumbar epidural injections (62311). I know that fluoro guidance is included with transforaminal epidural injections (64479–64484), but I was recently told that it is also included with 62310–62311. Is this true?    

Answer:

Answer:

Fluoro guidance is not included in 62310–62319, and 77003 may be separately assigned when fluoro guidance is necessary, according to the guidelines in the Spine and Spinal Cord, Injection, Drainage, or Aspiration (62263–62319) section of the 2016CPT book. 

77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid)

However, in the 2015 Medicare Physician Fee Schedule (MPFS) final rule, the Centers for Medicare & Medicaid Services indicated its intent to prohibit separate billing of imaging guidance for 62310–62319. Specifically: 

“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.”

CCI edits bundling 77003 with 62310-62319 were added in 2Q 2015 and made effective 1/1/2015.

The 2016 National Correct Coding Initiative Policy Manual For Medicare Services added the following statement to chapter 8: 

“CPT codes 62310-62319 describe injections of diagnostic or therapeutic substance(s) into the epidural or subarachnoid spaces at different spinal levels. Fluoroscopic guidance such as CPT code 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid))is included in these procedures and should not be reported separately with these codes.”

Other payers may allow 77003 with 62310–62319.