CPT Codes 77002, not 77003 with 64640

If your payer denies 77003 when you bill it with 64640, stating that the codes are mutually exclusive, can you use 77002 instead for the guidance (C-arm imaging) of the needle?

Yes you can use 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]). This often is the complaint CPT code to report in conjunction with 64640 (desctruction by neurolytic agent; other peripheral nerve or branch). 

The reason is: Code 77002 describes fluoroscopic guidance during pain management injection procedures when your physician needs guidance for needle placement in areas other than the spine. If you submit 64640, it signals the payer that you’re not reporting a spinal injection. 

Code 77003 is for fluoroscopic guidance of the procedures included in the descriptor. The injection represented by 64640 falls outside those parameters. 

If your provider performed the destruction procedure in an ambulatory surgery center or hospital outpatient department, append modifier 26 (professional component) to report your provider’s professional component of the fluoro-scopic needle guidance. 

You also need to check with your local payer about specific guidelines for these procedures. The most recent CCI edits do not bundle 77002 and 64640 as a comprehensive/component pair or as mutually exclusive. But you need to keep a check on whether your local payer has different bundling policies. 

If you want to know more on this and get the complete list of CPT codes, there are various one-stop medical coding websites to get you there. Some websites also offer free trial, which you can choose to go for before registering yourself for one. So get going!

CPT/HCPCS Coding Changes

CPT is the acronym for Current Procedural Terminology while HCPCS stands for Healthcare Common Procedure Coding System. While the former is a uniform coding system comprising descriptive terms and identifying codes that are used to identify medical services and procedures provided by physicians and other healthcare professionals, the latter is a standardized coding system that is mainly used to identify products, supplies and services not found in the CPT. HCPCS lookup is normally referred to Level II HCPCS codes. 

At the start of every calendar year, CPT and HCPCS code sets and manuals are updated; the changes are inclusive of coding additions, deletions and replacements. 

The HIPAA transaction and code set rule calls for usage of the code set that is valid at the time that the service is provided. There’s no grace period as such during which discontinued codes may be used. 

In order to boost timely payment of claims, all CPT and HCPCS codes submitted for reimbursement must be current and active as on the date on which the service is provided. 

For the most current CPT HCPCS codes, there are one-stop medical coding websites where you can head to. Such one-stop shop websites teach coders to make use of CPT HCPCS codes using real world medical examples. 

Such comprehensive resources also help just-in coders succeed by providing basic instruction on the structure, rules, and guidelines relating to CPT/ HCPCS coding. Here, you can even find the most common coding issues you are likely to encounter as a beginner in this profession. 

So if you are looking for a complete explanation of symbols and formatting used in CPT/HCPCS coding, these one stop shops are just right for you.

Oncology CPT codes For Simulation Claims

Since you have only one chance to report simulation per treatment course, you should nab the right code the very first time by focusing on the number of ports, treatment volumes and treatment devices.

You can choose four simulation codes from the CPT basket: 

77280 - therapeutic radiology simulation-aided field setting; simple

77285 - Intermediate

77290 - Complex

77295 - 3-dimensional

Each code has both professional and technical components, so be sure to append modifier 26 (professional component) when reporting only the physician’ services.

If your coding software doesn’t alert you when modifier 26 is an option, see if you can enter notes manually for a pop-up reminder. 

77280 is right for a single treatment area with either a single port or parallel opposed ports and simple or no blocking, as per CPT guidelines preceding the simulation codes. 

If the simulation involves three or more converging ports, two separate treatment areas, or multiple blocks, according to CPT guidelines, 77285 is the right code. 

If you are to report 77290, the simulation should involve three or more treatment areas, tangential ports, rotation or arc therapy, complex blocking, custom shielding blocks, brachytherapy source verification, contrast use or hyperthermia, according to CPT guidelines. 

77295 calls for documentation of computer-generated 3-D reconstruction of tumor volume and surrounding critical normal tissue from CT or MRI data to prepare for therapy, as laid down in CPT guidelines. 

To get more insight on CPT codes for oncology, you can register yourself for one-stop medical coding websites, where you’ll get the entire CPT code list, the latest changes, among a host of other coding know how.