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Leorah Posted Tue 09th of May, 2017 14:50:57 PM
Hi, The doctor removed 15 Ml of fluid from the patient and sent for sampling, then 5ml of intrathecal chemotherapy regimen was administered. This was done with fluoroscopy. 5cc of CSF was used as replacement and the needle was removed. What CPT codes should I be using? I used 96450 and 77003. Was that correct? Thanks!
SuperCoder Answered Wed 10th of May, 2017 06:33:47 AM


The administration of the chemotherapy is reported with CPT code 96450 (Chemotherapy administration, into CNS [e.g., intrathecal], requiring and including spinal puncture) by the physician who performed the chemo administration as well as lumbar puncture. But, in case, chemo administration is performed by one physician and lumbar puncture is performed by another, then the physician performing chemotherapy need to append modifier-52 (reduced service modifer) with CPT code 96450 (i.e 96450-52). The physician performing lumbar puncture will use CPT code 62270 with no modifier because he performed the entire puncture procedure as per CPT description. In order to report flouroscopy, use CPT code 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)}


Leorah Posted Thu 11th of May, 2017 02:48:47 AM
I just want to make sure I understand. In this case where the doctor performed chemotherapy administration as well as the lumbar puncture. I would code 96450, without a modifier, 62270, without a modifier, and 77003 with a 26 and 59 modifier? Thank you!
SuperCoder Answered Fri 12th of May, 2017 03:47:20 AM


I would repeat again. For doctor (oncologist for e.g.) performing chemo administration as well as spinal puncture under flouro, report CPT code 96450 wth 77003. For doctor (oncologist) performing only chemo administration under flouro without spinal puncture, report CPT code 96450-52 wth 77003. For doctor (radiologist for e.g.) performing spinal puncture only without chemo administration, report CPT code 62270 with 77003 for flouro with no modifier. Modifier 26 is appropriate when the physician supervises and interprets a diagnostic test, even if he or she does not perform the test personally. If the provider who interprets the film also owns the equipment, a global service is submitted and the professional and technical components are billed together, i.e. CPT code is reported no modifier, neither 26 nor TC. The technical component (TC modifier) of a service includes the provision of all equipment, supplies, personnel, and costs related to the performance of the exam.


Leorah Posted Tue 16th of May, 2017 04:43:01 AM
Thank you!
SuperCoder Answered Wed 17th of May, 2017 02:17:10 AM

You are welcome

Leorah Posted Tue 25th of July, 2017 14:37:49 PM
I coded the 96450 and the 77003 and the 96450 was paid by Medicare but the 77003 was not. The denial reason was that 77003 is an add on code and it cannot be coded with the 96450 according to CMS. Please advise Thanks
SuperCoder Answered Wed 26th of July, 2017 04:42:19 AM


Upon further exploration, our coding experts have found out that there are some payers who accept CPT code 77003 with 96450, but there are a few payers who deny, including Medicare, to bill these codes together, so this is payer specific. So, in this case, the only appropriate CPT code you may bill is 96450.


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