Review Results for Service Specific Post-Payment Review of Fluoroscopic Guidance for Needle Placement

Background

In an effort to reduce the Part B CERT error rate, the MR Department conducted a service specific post payment review of CPT code 77002 (Fluoroscopic guidance for needle placement). The primary focus of these audits was to determine whether the medical necessity of the services billed was at the correct code per Medicare guidelines.

National Government Services randomly selected 777 claims billed for CPT 77002 for post payment review in Jurisdiction 6 for Part B providers in the states of Illinois, Minnesota and Wisconsin.

• 77002 – Fluoroscopic guidance for needle placement

Results

Decision	Number of Claims
Allow	491
Deny	61
Non-Response Denial	224
Rescinded Review	1

• 462 claims from Illinois with 264 allowed and 198 denied for a claims error rate of 42.86%
• 147 claim from Minnesota with 113 allowed and 34 denied for a claims error rate of 23.13%
• 168 claims from Wisconsin with 114 allowed and 54 denied for a claims error rate of 32.14%

Key Reasons Services Were Denied

• Documentation did not support medically necessity due to one or more of the following: the medical records did not clearly indicate the use of fluoroscopic guidance was the most appropriate imaging procedure for the particular symptoms or medical condition of a patient; records must support the fluoroscopy procedure was medically justified given a patient's signs and symptoms, or when an alternative lower-dose examination is possible;
• Documentation was insufficient or incomplete
• Failure to respond to the request for documentation

Recommendations

• Send the requested records within the requested time frame to avoid a denial for no documentation.
• Familiarize yourself with available Fluoroscopic guidance for needle placement guidelines and other CMS publications listed below.
• Share this information with your coding personnel to ensure they are properly billing before sending the claim to Medicare.
• If you feel your application of this code is correct, ensure your documentation supports your usage.

Related Content

• Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, Section 1862(a)(1)(A)- Exclusions from Coverage and Medicare as a Secondary
• Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, Section 1833(e)- Payment of Benefits
• 42 CFR Section 410.32, Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions. Tests not ordered by the physician (or other qualified non-physician provider) who is treating the beneficiary are not reasonable and necessary (see Sec. 411.15(k)(1) of this chapter)
• National Correct Coding Initiative Chapter IX – Radiology Services

Posted 12/8/2021