CPT Coding Changes for January 1, 2011 (Oklahoma)

The ABInsight dated December 7, 2010 reported effective January 1, 2011, CPT 77003 (fluoroguide) can no longer be billed in addition to CPT’s 64479, 64480, 64483, and 64484 (transforaminal epidural injections).  The fluoroguide will now be considered inclusive to the injection; therefore, you will not be reimbursed separately for 77003 when these injections are given.  This is a CPT coding change and not just a National Correct Coding Initiative (NCCI) edit.

While this impacts all insurance plans, we chose only to show the per unit impact for BlueCross BlueShield of Oklahoma (BCBS) and Medicare.

We understand, at this point, there will be no increase in the amounts allowed for the injections with BCBS.  Medicare made minor changes in the allowable amounts.   Please keep in mind, the fluoroscopy reimbursement is only affected when done with the 64479-64484 injections.  At this time, the fluoroscopy is still being allowed with other procedures (eg, 62267, 62270-62282, 62310-62319).

Basically, for every patient you see in 2011 and provide transforaminal epidural injections for, you will realize a net decrease in income from the 2010 rates.

2011 Oklahoma Medicare and BCBS Allowables

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The information included in this publication is provided, among other things, to alert you to legal developments and should not be considered legal advice.  Specific questions about how this information affects your particular situation should be addressed to your attorney.

Editor:  Philip Blann (pblann@anesthesiabilling.com).