77002 CPT Code (2023) | Description, Guidelines, Reimbursement, Modifiers & Example

The 77002 CPT code can be used 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.

Description of the 77002 CPT Code

Fluoroscopic guidance utilizes to place a needle in a precise location. It is an X-ray technique that shows movement in real-time using 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 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 (add-on code) in conjunction with a primary procedure code. It is not appropriate to report separately. 

CPT code 77002 may be used 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.

The official description of the 77002 CPT code is: “”

Reimbursement

A maximum of one unit can be a bill on the same service date of CPT code 77002. In contrast, the three units allow 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.

Billing Guidelines

If ablation therapy (20982-20983) performs in conjunction with 77002, reporting CPT 77002 separately with the modifier is appropriate.

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.

If autologous adipose-derived regenerative cell therapy partial-thickness rotator cuff tear (0717T-0718T) is performed with 77002. In that case, reporting the 77002 CPT code separately with the modifier is appropriate.

If biopsy, breast, with placement breast localization device(s) (19081-19086) is performed in conjunction with 77002. In that case, reporting the 77002 CPT code separately with the modifier is appropriate.

If omage-guided fluid collection drainage by catheter (10030) is used in conjunction with CPT code 77002. You can report 77002 separately with a modifier.

Billing Examples

Below are some examples of cases when CPT 77002 can be reported.

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. To proceed, the physician discussed the risks, benefits, and alternatives, including infection, tendon rupture, skin depigmentation, and fat atrophy. 

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

Medicaitons: 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 and 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.