Coding questions

[MD87]

1) For SIJ in an ASC, I just learned that Medicare wants g0260 and 77002, NOT 27096. Does anyone know whether this is true fur any private insurances?

2) Medicare says a facet joint cyst aspiration/rupture is 64999... are any of you billing this? I have heard the code doesn't pay anything. I previously had been billing a 1 level facet joint injection and if I do a TFESI I will also bill the TFESI. Now I"m not sure what's correct?

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[clubdeac]

1) For SIJ in an ASC, I just learned that Medicare wants g0260 and 77002, NOT 27096. Does anyone know whether this is true fur any private insurances?

2) Medicare says a facet joint cyst aspiration/rupture is 64999... are any of you billing this? I have heard the code doesn't pay anything. I previously had been billing a 1 level facet joint injection and if I do a TFESI I will also bill the TFESI. Now I"m not sure what's correct?

They’re ripping you off. I’d just document it as a facet injection, and then say you aspirated/ruptured the cyst in the fine print

 

[Ducttape]

should be a facet injection. document the facet injection and attempted aspiration after successful placement.

i have not heard that g0260 is to be used. is that coming from the ASC? because medicare states that fluoroscopy is to be bundled with the SIJ.

 

[Taus]

1) For SIJ in an ASC, I just learned that Medicare wants g0260 and 77002, NOT 27096. Does anyone know whether this is true fur any private insurances?

2) Medicare says a facet joint cyst aspiration/rupture is 64999... are any of you billing this? I have heard the code doesn't pay anything. I previously had been billing a 1 level facet joint injection and if I do a TFESI I will also bill the TFESI. Now I"m not sure what's correct?

1- my surgery center said the same thing about a year or so ago. I have carried on business as usual billing the original code. Perhaps that is what they need to bill for the facility fee in Asc?

2- I have always billed the esi code plus facet w 59 modifier. As I am doing these for radiculopathy from the cyst, and esi pays more, I always bill for the lesi or tfesi as primary code. I do recall reading something in the Medicare LCD and one of the commercial carriers a few years ago about this being the only circumstance you can bill both codes.

 

[MD87]

should be a facet injection. document the facet injection and attempted aspiration after successful placement.

i have not heard that g0260 is to be used. is that coming from the ASC? because medicare states that fluoroscopy is to be bundled with the SIJ.

Article - Billing and Coding: Sacroiliac Joint Injections and Procedures (A59233)

Use this page to view details for the Local Coverage Article for Billing and Coding: Sacroiliac Joint Injections and Procedures.

www.cms.gov

 

[Ducttape]

you are not the facility.

you are the physician. you do not report the G code.

Physician services in an ASC setting should report codes as noted above in the section on Professional services performed by the physician.

which is this part:

For professional services performed by the physician:

Bilateral SIJIs procedures reported with CPT 27096 or 64451 should be reported with modifier 50. If a unilateral joint injection (CPT 27096) is performed and a unilateral sacral nerve block (CPT 64451) is performed on the contralateral side do not report modifier 50 with either code. Do not report a sacroiliac joint injection (CPT 27096) and a block of the nerves innervating the sacroiliac joint (CPT 64451) for the same side, per the policy.

 

[potcake76]

you are not the facility.

you are the physician. you do not report the G code.

Physician services in an ASC setting should report codes as noted above in the section on Professional services performed by the physician.

which is this part:

For professional services performed by the physician:

Bilateral SIJIs procedures reported with CPT 27096 or 64451 should be reported with modifier 50. If a unilateral joint injection (CPT 27096) is performed and a unilateral sacral nerve block (CPT 64451) is performed on the contralateral side do not report modifier 50 with either code. Do not report a sacroiliac joint injection (CPT 27096) and a block of the nerves innervating the sacroiliac joint (CPT 64451) for the same side, per the policy.

This is the right answer.