Grundel76

Full Member
10+ Year Member
5+ Year Member
Apr 2, 2008
14
0
Status (Visible)
  1. Fellow [Any Field]
A little help here...

I do all of my procedures either in an ASC or in my office. I've been coding my SI joint injections under fluoro as 27096 but just realized that it is not paid if done in an ASC. Any way around that? Should I just code for multiple peripheral nerve injections and just inject lateral to the sacral foramen? How have you guys been doing this?

Also, when do you use 77002 vs. 77003 for fluoro for ESI, facets, etc...
My Ingenix CPT book definitions are confusing, esp for 77003...

thanks
 

PMR 4 MSK

Large Member
10+ Year Member
5+ Year Member
Oct 2, 2007
4,182
30
Status (Visible)
  1. Attending Physician
Coverage for 27096 in ASC's varies. Medicare didn't used to cover it in my state, now they do. Most private insurances have for me.

However, if they don't cover it at the ASC, you cannot do it there and bill it as something else. You might get paid, but an audit could result in a fraud lawsuit against you. You have to work with the rules, not around them. Do them "blind" in the office, or find a hospital to do them at. I used to have to do most SI's at the hospital across the street.

77003 is used for ESI's, SNRB's, facets, SIJI and other spine procedures. 77002 is anything else - ribs, peripheral nerves, joints, tendons, etc.
 

lobelsteve

Full Member
Staff member
Volunteer Staff
15+ Year Member
May 30, 2005
16,579
6,592
Canton GA
www.stevenlobel.com
Status (Visible)
  1. Attending Physician
Coverage for 27096 in ASC's varies. Medicare didn't used to cover it in my state, now they do. Most private insurances have for me.

However, if they don't cover it at the ASC, you cannot do it there and bill it as something else. You might get paid, but an audit could result in a fraud lawsuit against you. You have to work with the rules, not around them. Do them "blind" in the office, or find a hospital to do them at. I used to have to do most SI's at the hospital across the street.

77003 is used for ESI's, SNRB's, facets, SIJI and other spine procedures. 77002 is anything else - ribs, peripheral nerves, joints, tendons, etc.

Agree with above except for the blind comment (though we all know it was meant as a joke).

The code for a blind SIJ injection is 20551. Most of us call that a trigger point.
 
About the Ads

PMR 4 MSK

Large Member
10+ Year Member
5+ Year Member
Oct 2, 2007
4,182
30
Status (Visible)
  1. Attending Physician
Agree with above except for the blind comment (though we all know it was meant as a joke).

The code for a blind SIJ injection is 20551. Most of us call that a trigger point.

Actually isn't 20551 for a tendon injection? 20552 is TPI.

What, you don't bill 27096 in the office w/o fluoro? :D
 

stim4u

Member
Removed
10+ Year Member
Dec 12, 2005
786
9
Status (Visible)
how are you billing L3,4,5,Ala RFA rhizotomy? How many fluro codes? what medications? Just curious what people are doing.
 

stim4u

Member
Removed
10+ Year Member
Dec 12, 2005
786
9
Status (Visible)
do you mean, for a L3-S1 RFA: 62622*1, 64623*3, 77003, J1040, J3490, Q9966. and maybe a tray code if the carrier covers it. any other codes, feasible?
 

Medcoder

New Member
10+ Year Member
Jan 26, 2009
1
0
Status (Visible)
  1. Pre-Health (Field Undecided)
For a superfast way to find the proper code and crosswalks, check out -advertisement- Best of all, you can use it for free for a limited time. Subscription pricing is very reasonable. :laugh:
 
Last edited by a moderator:
About the Ads
This thread is more than 12 years old.

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.