Health Information Management

Q&A: Why do we receive an edit when reporting fluoroscopy?

APCs Insider, May 22, 2015

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Q: We have started receiving an edit for our pain management procedures reported with CPT® codes 62310 (injection of diagnostic or therapeutic substances, not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic) and 62311 (lumbar or sacral) along with fluoroscopy code 77003 (fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural or subarachnoid]). 
We know that this is a correct pairing based on CPT instructions, but we are getting an edit that this is not allowable. 
A: There is a new NCCI edit related to this that was added April 1, and it is retroactive to January 1, 2015. The edit is in conflict with the 2015 CPT guidelines that state fluoroscopic guidance is not included in codes 62310 and 62311 and, if utilized, should be reported with 77003.
The basis for the NCCI procedure-to-procedure edits for 77003 with the codes in the range of 62310–62319 are based on information in the 2015 Medicare Physician Fee Schedule (MPFS) final rule. In that rule, CMS says it believes codes 62310–62319 have been valued to include fluoroscopic guidance, and therefore, reporting the fluoroscopy codes with these procedures is over-reporting the resources involved in the service. In the MPFS final rule (CMS 1612-FC), CMS noted:
After considering comments received, we are finalizing CPT codes 62310, 62311, 62318, and 62319 as potentially misvalued, finalizing the proposed RVUs[relative value units] for these services, and prohibiting separate billing of image guidance in conjunction with these services.
While this was published in the MPFS final rule, the NCCI has applied the edit across the board. Based on communication with the NCCI regarding this edit, they are required to incorporate information from the final rules into the edits. CMS guidance for reporting services does conflict with AMA/CPT guidance at times. Providers should check with non-Medicare payers to establish appropriate reporting under those contracts.
Editor’s note: Denise Williams, RN, CPC-H, seniorvice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Fort Lauderdale, Florida, answered this question.

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