Use of guidance is very common for performing any radiology diagnostic exam. Interventional radiology CPT codes are mostly accompanied by guidance CPT codes. Fluoroscopy, Ultrasound, Computed tomography, MRI guidance etc. are some of guidance used with diagnostic radiology CPT codes. Now, with the new updates every year these guidance are mostly bundled with the main procedure codes. For example, breast biopsy CPT codes are now bundled with guidance CPT codes and so only one CPT code will represent the whole breast biopsy procedure. But, there are very different specific guidance CPT codes used for vascular and non-vascular procedure. This article will focus on the different guidance CPT codes used for particular procedures. If you understand these codes, it will be really help you in clearing CPC or CIRCC exam in future. Let use checkout the commonly used guidance codes.

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Difference Between CPT code 76942 and 76937

CPT code 76942 and 76937 are ultrasound guidance used for non-vascular and vascular procedures respectively. CPT code 76942 is used only for biopsy, injection, aspiration etc. and should be coded only with non-vascular procedures. I have already share an article about the CPT code 76942 which will give more information about this CPT code. This code is used in biopsy like thyroid biopsy, lung biopsy, breast biopsy and injection procedure like arthrogram, arthrocentesis etc. Only one thing should be always remembered, CPT code 76942 is only used for non-vascular procedure.

For vascular procedures we have separate Ultrasound guidance procedure code 76937. This code is only used for vascular diagnostic and intervention procedure. For placement of central venous catheter, stent placement, angioplasty, AV fistula exam etc. all these vascular procedures require ultrasound guidance. But CPT code 76937 need three valuable criteria to qualify for coding. If any of these criteria is not documented in medical report, we are not suppose bill ultrasound guidance CPT 76937. Below are the three important points to be documented in the medical report

• The patency of the blood vessel
• Insertion of catheter under real-time ultrasound guidance
• Permanent recorded image(s) of the vascular access site

If all these point are documented then only use can bill for CPT code 76937.

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When to code CPT code 77001

Like ultrasound, for vascular procedure we have separate fluoroscopic guidance code 77001. This CPT code is used for all vascular procedure including all the diagnostic and intervention procedures. Fluoroscopic guidance mainly helps in vascular central venous catheter placement procedures. This code is used along with ultrasound guidance procedure code 76937 in vascular procedures coding.

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Description of CPT code 77002 and 77003

From 2017, the CPT code description of 77002 and 77003 has been revised and the new code description for these codes is as follows.

+77002 – Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure) 

+77003 – Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (List separately in addition to code for primary procedure) 

These two CPT codes are now designated as add-on codes. Also, CPT  revises  the descriptors to include the parenthetical note (List separately in addition to code for primary procedure) and revises the global periods for both codes to reflect an add-on code; a global value ZZZ. Additional modifications were made to the instructions and vignettes for each code in the CPT manual. 

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When to use CPT code 77002 and 77003

These fluoroscopic CPT codes are used only for non-vascular procedures. For biopsies, injection (except spinal injection) procedure only fluoroscopic guidance 77002 CPT code is used. For spinal injection like epidural injection, lumbar puncture, myelogram etc. we used only CPT code 77003 as fluoroscopic guidance. For diagnostic exam of joints like arthrogram, arthrocentesis procedures we use only 77002 CPT code. For all the spinal diagnostic exam we will use 77003 CPT code.