ASC coding help

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Grundel76

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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

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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

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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.
 

PMR 4 MSK

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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

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how are you billing L3,4,5,Ala RFA rhizotomy? How many fluro codes? what medications? Just curious what people are doing.
 

PAINBILLER

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how are you billing L3,4,5,Ala RFA rhizotomy? How many fluro codes? what medications? Just curious what people are doing.

64622, 64623, 77003

What meds are you using?
 

stim4u

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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

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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:
 
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