Table of Contents

Basic about Cpt Code 77003

Guidance codes are important in Interventional radiology coding. Percutaneous surgery procedure is mostly depending upon guidance like ultrasound or fluoroscopic guidance. The imaging guidance CPT codes are different for vascular and non-vascular percutaneous procedures like CPT code 77003 is used for non-vascular exam like spinal procedure and 77001 for vascular procedure like central line placement. For ultrasound guidance also we have separate codes for vascular and non-vascular percutaneous procedure. Cpt Code 76937 is used for vascular procedure and 76942 cpt code is used for non-vascular procedure like biopsy. This differences between vascular and non-vascular procedures really helps in improving our skills in coding ICD and CPT codes. Let’s learn which are the CPT codes are used with CPT code 77003. This guidance is used with very less procedure codes but very important one. Cpt Code 77003 is used mainly in spinal injection procedures.

Coding guidelines for CPT code 77003

CPT code description of addon code +77003 is given below.

+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)

The CPT code 77003 is revised with 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

Procedures use CPT code 77003

The steroid injection procedure of spine use fluoroscopic guidance CPT Code 77003. The different cpt codes used for steroid epidural injection are 62310 (deleted in 2017), 62311 (deleted in 2017) and 27096. The steroid injection is injected into the epidural or subarachnoid space of the spine. The CPT code 77003 was included with procedure code 62310 and 62311. Cpt Code 77003 is included with 27096 also hence we are not allowed to code it separately.

There are separate codes for injection in facet joints or Z joints. The facet or Z joint is the bony surfaces between vertebrae that articulate with each other. The CPT codes used for facet joint injection, ranges from 64490-64495. Copt Code 77003 should not be report with CPT codes 64490-64495. A facet joint injection code includes fluoroscopic guidance CPT Code 77003.

Epidurography should only be reported when it is reasonable and medically necessary to perform a diagnostic study. Epidurography should not be billed when the contrast injection is part of the fluoroscopic guidance and contrast injection to confirm correct needle placement that is integral to the epidural, transforaminal and intrathecal injections addressed in the policy. For example, CPT code 72275 (Epidurography, radiological supervision and interpretation) differs from CPT code 77003 in that it represents a formal recorded and reported contrast study that includes
fluoroscopy.

USE of CPT codes for 62310 and 62311

New codes have replaced from 2017 for steriod injections. Below is the code description for the new codes.

62320 (Injection[s], of diagnostic or therapeutic substance[s] [eg, anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance).

62322 (Injection[s], of diagnostic or therapeutic substance[s] [eg, anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral [caudal]; without imaging guidance).

Lumber puncture with CPT code 77003

Lumbar puncture procedures are performed under fluoroscopic guidance. Cpt Code 77003 should not be coded with Lumbar puncture CPT Code 62270 as per updated coding guidelines. Even when therapeutic spinal puncture procedure use fluoroscopic guidance 77003. Do not code CPT code 77003 along with spinal puncture procedure (CPT code 62270 & 62328) since they are included in the main procedure code.

If any ultrasound or MRI guidance is performed during spinal procedure they can be reported with CPT code 76942 & 77021 simultaneously.

Other related Synonyms for Fluoroscopic guidance code 77003

Fluoroscopic guidance and localization of catheter tip for epidural injection procedure on spine
Fluoroscopic guidance for injection into spine or muscle next to spine
Fluoroscopic guidance and localization of needle tip for epidural injection procedure on spine
Fluoroscopic guidance and localization of needle tip for subarachnoid injection procedure on spine
Fluoroscopic guidance and localization of catheter tip
Fluoroscopic guidance and localization of needle
Fluoroscopic guidance and localization of catheter tip for subarachnoid injection procedure on spine

Additional Code Information for CPT code 77003

PC/TC Indicator (26):1 = Diagnostic Tests for Radiology Services

Multiple Procedures (51):0 = No payment adjustment rules for multiple procedures apply

Bilateral Surgery (50):0 = 150% payment adjustment for bilateral procedures does not apply

Physician Supervision:09 = Concept does not apply

Assistant Surgeon (80,82):0 = Payment restriction for assistants at surgery applies to this procedure unless supporting documentation is submitted

Co-Surgeons (62):0 = Co-surgeons not permitted for this procedure

Team Surgery (66):0 = Team surgeons not permitted for this procedure

Diagnostic Imaging Family:99 = Concept does not apply

Do and Don’t with Procedure code 77003

Code 77003 is an Add-on code, per coding guidelines “Do not append modifier 51 to additional procedure code

For Paravertebral Spinal Nerves and Branches – Image guidance [fluoroscopy or CT] and any injection of contrast are inclusive components of 64490-64495.

Do not report 64633-64636 in conjunction with 77003, 77012)
62264 includes codes 72275 and 77003
Do not report 62323 in conjunction with 77003, 77012, 76942
Do not report 62327 in conjunction with 77003, 77012, 76942
If fluoroscopic guidance is performed, use 77003
Do not report codes 22526, 22527 in conjunction with 77002, 77003)
Do not report 10030 in conjunction with 75989, 76942, 77002, 77003, 77012, 77021)
72275 includes 77003
Do not report 49407 in conjunction with 75989, 76942, 77002, 77003, 77012, 77021
62263 includes codes 72275 and 77003
Do not report 49405 in conjunction with 75989, 76942, 77002, 77003, 77012, 77021
Do not report 62321 in conjunction with 77003, 77012, 76942
Do not report 64461, 64462, 64463 in conjunction with 62320, 62324, 64420, 64421, 64479, 64480, 64490, 64491, 64492, 76942, 77002, 77003
Do not report 62325 in conjunction with 77003, 77012, 76942

Coded Sample charts for CPT code 77003

Indications

Cervical disc herniation with neck and upper extremity pain, failing conservative therapy. Contraindications: There were no contraindications. Informed consent was obtained and placed into the chart prior to the procedure.

Description of procedure

The patient was brought into the fluoroscopy suite, placed prone on the fluoroscopy table. Posterior cervical spine was prepped and draped in a sterile manner using triple Betadine wash. A 25-guage 1.5 inch needle was used to create a local anesthetic skin track using 1% lidocaine. The left C7 lamina was targeted and using a 20-guage Tuohy needle, the needle was advanced carefully towards the superior edge of the lamina. Using the loss-of-resistance technique under lateral imaging, the posterior epidural space was identified. 1 cc of Isovue was injected with good posterior epidural flow and no vascular uptake. There was negative aspiration of blood or CSF. A total volume of 5 cc was then injected, including 3 cc of betamethasone and 2 cc of preservative-free normal saline. The patient tolerated the procedure very well. Needle was removed. Band-Aid was applied. The patient is transferred to the recovery room in good condition. No complications were noted. The patient tolerated the procedure very well. Needle was removed. Band-Aid was applied. The patient is transferred to the recovery room in good condition. No complications were noted.

CPT code – 62310, 77003-26