Tuesday, June 29, 2010

Billing and payment guide for ASC


This advisory discusses Medicare coding, coverage and payment for mobile fluoroscopy
guidance during pain management procedures2, 3 when performed in the hospital inpatient,
hospital outpatient department, independent diagnostic testing facility (IDTF) and physician
office settings.4 While it focuses on Medicare program policies, these policies may also be
applicable to selected private payers throughout the country.


Medicare’s reimbursement system relies mostly on Current Procedural Terminology (CPT)
codes to consistently identify diagnostic imaging procedures provided to Medicare patients.5
The CPT coding system was developed and is maintained by the American Medical Association
(AMA) and the codes are updated annually. Updates for 2007 by the AMA include a significant
number of procedures being relocated to more appropriate sections within the CPT coding
structure. This relocation has resulted in the deletion and replacement of a considerable number
of CPT codes.6

Coding for Pain Management Procedures

There are a wide variety of pain management procedures. A listing of pain management
procedures and their related CPT codes is included in Table 1. This listing was developed based
on the following information sources: (1) procedures and codes identified by the American
Society of Interventional Pain Physicians, (2) additional codes listed in AMA coding
documentation as being included in the pain management coding series and (3) Healthcare
Common Procedure Coding System (HCPCS) codes developed by the Centers for Medicare and Medicaid Services (CMS) to report selected pain management procedures to the Medicare
program. It is important to note that inclusion of a procedure on this list does not denote
coverage or payment of the procedure.

Coding for Fluoroscopic Guidance and Localization
There are two CPT codes used to report fluoroscopic guidance and localization during pain
management injection procedures.
CPT 77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization
CPT 77003
Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous
diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid,
paravertebral facet joint, paravertebral facet joint nerve, or sacroiliac joint), including neurolytic
agent destruction

CPT code 77002 is used to report fluoroscopic guidance of all anatomical areas except the spine;
CPT code 77003 is used to report fluoroscopic guidance and localization of the spinal anatomy.

It is important to note that there are general limitations on the use of fluoroscopy codes. With
respect to coding of fluoroscopy procedures, the American College of Radiology (ACR) points
out “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.” In these cases,
fluoroscopy should not be coded or reported separately.7 Additionally, injection of contrast
during fluoroscopic guidance and localization is an inclusive component of pain management
codes and is not separately report.

There are more specific limitations with respect to the use of the codes listed above, as well as
limitations on reporting each of these codes separately with pain management injection
procedures. Table 2 summarizes guidance from the AMA and the ACR on when it is appropriate
to report fluoroscopy separately during pain management procedures. However, providers
should confirm that their local Medicare contractor has not published coding instructions
different than or inconsistent with this guidance before billing Medicare for fluoroscopy in
conjunction with pain management procedures.

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