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!