77002 cpt code

(2022) 77002 CPT Code Description, Guidelines, Reimbursement, Modifiers & Examples

77002 CPT code bills for service when the physician performs service under fluoroscopic guidance for needle placement in addition to the primary procedure such as injection, aspiration, biopsy, and localization device.

77002 CPT Code Description

Fluoroscopic guidance utilizes to place a needle in a precise location. It is an x-ray technique that shows movement in real-time with the aid of contrast dye. 

77002 CPT code typically reports when the physician performs a needle biopsy or finds needle aspiration. It produces an X-ray to visualize anatomy, insertion, and contrast on the screen. A core needle or fine needle incorporates the target area and ensures the position by fluoroscopy. 

The following are the reason why physicians perform fluoroscopy:

To evaluate different body areas or organs

Utilizes several diagnostic procedures such as arthrography, barium X-rays, lumbar puncture, biopsies

To consider for  IV catheter insertion, Pyelogram, hysterosalpingogram, etc. 

To identify foreign bodies

Steroids or trigger injections into joints or the spine

Percutaneous vertebroplasty to treat compression fractures

77002 CPT code always bills as a secondary procedure code in conjunction with a primary procedure code. It is not appropriate to report separately. 

CPT code 77002 bills for service when the physician performs service under fluoroscopic guidance for needle placement in addition to the primary procedure such as injection, aspiration, biopsy, and localization device.

cpt code 77002

77002 CPT Code Reimbursement

A maximum of one unit can be a bill on the same service date of CPT code 77002. In contrast, the Three unit allows when documentation supports the medical necessity of the service. 

The cost and RUVS of 77002 CPT code with modifier 26 are $29.58 and 0.85470 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 77002 with modifier 26 are $29.58 and 0.85470 when performed in the non-facility.

The cost and RUVS of 77002 with modifier TC are $109.24 and 3.15657 when performed in the facility. In contrast, the reimbursement and RUVS of 77002 CPT code with modifier TC are $109.24 and 3.15657 when performed in the non-facility.

The cost and RUVS of 77002 with global billing are 138.81 and 4.01127 when performed in the facility. In contrast, the reimbursement and RUVS of 77002 CPT code with global billing are 138.81 and 4.01127 when performed in the non-facility.

77002 CPT Code Billing Guidelines

The surgical procedure (10160, 20206, 20220, 20225, 20520, 20525-20526, 47000-47001, 48102, 49180 20550, 20551, 20552, 20553, 20555, 20600, 20605, 20610, 21550, 23350, 24220, 25246, 27093-27095, 27369, 27648, 32400, 32553, 36002, 38220-38222, 38505, 38794, 41019, 42400-42405, 49411, 50200, 50390, 51100-51102, 55700, 55876, 60100, 20612, 20615, 21116, 62268-62269, 64400-64448, 64450, 64455, 64505, 64600-64605) must report first in combination with CPT code 77002.

If Ablation therapy (20982-20983) performs in conjunction with 77002, it is appropriate to report CPT 77002 separately with the modifier.

77002 CPT code excludes any procedure codes that include fluoroscopic guidance in code descriptors such as:

Percutaneous drainage by catheter (75989) and Transhepatic portography (75885, 75887)

If Arthrography procedure(s) (70332, 73040, 73085, 73115, 73525, 73580, 73615)) performs in conjunction with CPT code 77002, it is appropriate to report 77002 separately with the modifier.

Suppose Autologous adipose-derived regenerative cell therapy partial-thickness rotator cuff tear (0717T-0718T) performs with 77002. In that case, it is appropriate to report 77002 CPT code separately with the modifier.

Suppose biopsy, breast, with placement breast localization device(s) (19081-19086) performs in conjunction with 77002. In that case, it is appropriate to report 77002 CPT code separately with the modifier.

Suppose Image-guided fluid collection drainage by catheter (10030) performs in conjunction with CPT code 77002. In that case, it is appropriate to report 77002 separately with the modifier.

Suppose the Placement breast localization device(s) (19281-19288) performs in conjunction with CPT code 77002. In that case, it is appropriate to report 77002 separately with the modifier.

Suppose Platelet-rich plasma injection(s) (0232T) performs in conjunction with 77002. In that case, it is appropriate to report 77002 CPT code separately with the modifier.

If Thoracentesis (32554-32557) performs in conjunction with CPT code 77002, it is appropriate to report 77002 separately with the modifier.

77002 cpt code description

77002 CPT Code Modifiers

The following are the list modifiers when 77002 CPT code bills: 

22, 23, 26, 52, 58, 59, 76, 77, 78, 79, 99, AI, AQ, AR, CC, CR, ET, EY, FX, FY, GA, GC, GK, GR, GU, GY, GZ, KX, PT, Q5, Q6, QJ, SG, TC, XR, XP, XU, XS. 

The most frequent bill modifiers are 26, TC, 77, 76, 59, or X {E, P, S, U} with 77002.   

Modifier 26 bills to indicate the professional component of services when attached with 77002. It shows that the Physician work as an employee in a hospital and facility, not owning the equipment. 

Modifier TC applicable with CPT code 77002 indicates the Technical component or machinery used in service. It usually bills with Hospital and facility claims. 

77002 bills globally when physician-owned the office and equipment. Service bills without TC and 26 modifiers.

Modifier 76 is applicable with CPT code 77002 when a similar service performs by the Same Physician on the same day. 

Modifier 76 is applicable with 77002 when a similar service performs by a different Physician on the same service date.

Modifier 59 is applicable with CPT code 77002 when a Distinct service performs by the physician and bundled with another procedure on the same date.  

Modifier X {E, P, S, U} is applicable instead of Modifier 59 with 77002 when service bills to medicare insurance. It divides the modifier into four parts for further specification of the procedure.

If physicians believe that Medicare will deny such service, reporting with a GA  modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and  78226 and 78227 must apply the GA modifier to that service.

Modifier 52 is applicable when the physician cannot complete the procedure due to unavoidable circumstances.

cpt 77002

77002 CPT Code Examples

The following are the example when CPT 77002 bills:

Example 1

LEFT HIP MRI INJECTION

Clinical information: Patient with left hip pain. The request made for the left hip MRI injection.

Operator: Dr. XYZ

Supervising physician: Dr. ABC

Informed consent obtains from the patient and his father. The physician discussed the risks, benefits, and alternatives, including infection, tendon rupture, skin depigmentation, and fat atrophy to proceed. 

The physician placed the patient in the supine position on the fluoroscopy table. Then, the appropriate puncture site was determined and marked.

The patient was prepared and dressed in a standard sterile fashion. The team timeout confirmed the appropriate patient identity and procedure.

The skin and subcutaneous tissues infiltrate with lidocaine.

Fluoroscopy Time: less than 1 minute

The 22-gauge spinal needle advance into the left hip joint. An eight cc of dilute gadoterate solution consisting of gadoterate and Omnipaque-180 injects the joint. A small amount of Omnipaque-180 infiltrates to confirm the appropriate needle position. 

The patient endured the procedure well, and there were no immediate complications. The patient transfers to MRI in stable condition.

Fluoroscopy time: Less than 6 seconds

Kerma area product equals 38.3 uGym2.

Impression:

Successful fluoroscopically guided left hip injection with the administration of 8 CC of dilute gadoterate solution for MR arthrography.

Example 2

Exam: Lap band port access and drainage: Dec X, 2022

HISTORY: 52-year-old male with a remote history of lap band surgery in 2008 who

presents with nausea. Access to the office was unsuccessful. Fluoroscopic guidance is requested.

Radiologists: Dr. XYZ

MEDICATIONS: Local anesthesia with 1 percent lidocaine. Fluoroscopy timeless then 0.1 minutes.

Procedure/findings: The patient was brought into the angiography suite and positioned supine on the fluoroscopy table. A combination of palpation fluoroscopy was used to identify the Port. A site was sterilely prepped and draped.

The proprietary access needle then advanced into the center of the Port utilizing palpation and fluoroscopy. Three CC of serous-saline was aspirated (not the 4.5 CC indicated). The access needle removes.

IMPRESSION: Fluoroscopic access of LAP-BAND port with the removal of 3 CC.

Example 3

EXAMINATION:  Right Hip steroid injection

CLINICAL INDICATION: Right hip pain.Limited joint range of motion (ROM)

Arthritis of the right hip

STEROID INJ OF 40 MG DEPO

FINDINGS: Right hip steroid injection performed with fluoroscopic guidance.

Informed consent obtains from the patient. The skin overlying the Right hip was prepped and draped.

Lidocaine uses as local anesthesia. A 20-gauge spinal needle advance into the Right hip joint with fluoroscopic guidance. The intra-articular position confirms by injecting a small amount of contrast. 

The physician administers  40 mg Depo-Medrol and 4 ml of 0.25% Marcaine into the Right hip joint. The patient tolerated the procedure well.

IMPRESSION:

Right hip steroid injection performs as described above.

Example 4

A 32 year-0ld female presents to the office with pain in her right hand. She accidentally triggered his finger four days ago. She took medication for pain relief, but it still did not resolve. 

The patient denies headache, shortness of breath, back pain, abdominal pain, nausea, vomiting, diarrhea, changes in vision, urinary complaints, or any other symptoms.

The physician ordered a trigger injection for pain.

Office and Lab Procedures: Trigger Finger Injection

Location: injection of tendon sheath Right Hand, Thumb 

Injectate: Lidocaine 1 mL; Celestone; 

Fluoroscopy time less than 0.1 minutes.

Procedure: The physician discussed the risks, benefits, and alternatives, including infection, tendon rupture, skin depigmentation, and fat atrophy. The patient consented to proceed with a cortisone injection into the flexor sheath of the right thumb. The patient tolerated the procedure well.

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