SIJ code change for asc

[Taus]

I have been told the following by my asc. Anyone else ever come across this?

“27096 is not reimbursed by Medicare when performed in an ASC. G0260 replaces 27096”

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[Agast]

Google tells me the facility bills that to Medicare only, and you still use 27096. All other payers 27096 for the ASC

 

[bedrock]

No insurance, including Medicare, will pay a facility fee for a SIJ injection. They consider SIJ similar to a peripheral joint injection.

I noticed this in my practice and moved all SIJ injections, genicular and SIJ blocks to our procedure room for IA hip injections and peripheral joint arthrograms etc, so our practice doesn’t waste ASC resources on procedures not paying ASC facility fees.

 

[Taus]

No insurance, including Medicare, will pay a facility fee for a SIJ injection. They consider SIJ similar to a peripheral joint injection.

I noticed this in my practice and moved all SIJ injections, genicular and SIJ blocks to our procedure room for IA hip and joint arthrograms etc, so our practice doesn’t waste ASC resources on procedures not paying ASC facility fees.

Very interesting. Thanks. My two offices are about 45 minutes apart, ASC is next to one of them, office fluoro the other. Therefore, not all patients, particularly older Medicare, want to drive to the office suite. I do one day of procedures at each per week.

So technically, I can still bill and get paid my paultry pro fee for 27096 and asc gets squat? I wonder what that G code pays them.

 

[NJPAIN]

I’d estimate it’s about 2 years since my ASC let me bring a Medicare SIJ inj. My choices are hospital or use US in office (no fluoro) realizing that US is not optimal. That said I’ve had some good therapeutic response to US guided steroid and PRP. However, I won’t / can’t use US for diagnostic purposes pre RF or fusion (yet to do one). I was in the hospital yesterday just to do an SIJ inj in an 85 yo. Probably cost more for fuel than reimbursement.

 

[bedrock]

Very interesting. Thanks. My two offices are about 45 minutes apart, ASC is next to one of them, office fluoro the other. Therefore, not all patients, particularly older Medicare, want to drive to the office suite. I do one day of procedures at each per week.

So technically, I can still bill and get paid my paultry pro fee for 27096 and asc gets squat? I wonder what that G code pays them.

In rural parts of the Rocky Mountains, older patients often have to drive 45 min for care, so your urban patients are a touch spoiled.

I think your ASC is making nothing on that G code and no one is noticing.

 

[Taus]

In rural parts of the Rocky Mountains, older patients often have to drive 45 min for care, so your urban patients are a touch spoiled.

I think your ASC is making nothing on that G code and no one is noticing.

Yeah. Agreed. My office near ASC is on the outskirts of suburbs, towards rural areas, so most have no problem driving for lower cost and less hassle of office office Fluoro. My fluoro suite is in affluent suburb right outside the city. Those patients often throw a hissy fit when they have to drive to asc for something I can’t/won’t do in office (stellate, c tfesi, etc)

 

[Agast]

TIL I’ve been losing the ASC tons of money with my joint injections and they’ve been too nice to say anything about it. I should stop scolding them when I’m mad.

 

[BobBarker]

You can take the joints to the hospital. They do great on SI joints and make around $250 for a major joint.

 

[Agast]

You can take the joints to the hospital. They do great on SI joints and make around $250 for a major joint.

Hospitals get $250 and ASC's get nothing? I hear @drusso singing...

 

[Ferrismonk]

I’d estimate it’s about 2 years since my ASC let me bring a Medicare SIJ inj. My choices are hospital or use US in office (no fluoro) realizing that US is not optimal. That said I’ve had some good therapeutic response to US guided steroid and PRP. However, I won’t / can’t use US for diagnostic purposes pre RF or fusion (yet to do one). I was in the hospital yesterday just to do an SIJ inj in an 85 yo. Probably cost more for fuel than reimbursement.

Keep in mind 27096 is inclusive of fluoro and an ultrasound guided injection does not qualify. You'd have to use 20611.

 

[drusso]

Hospitals get $250 and ASC's get nothing? I hear @drusso singing...

As you wish...

 

[Nodolor]

No insurance, including Medicare, will pay a facility fee for a SIJ injection. They consider SIJ similar to a peripheral joint injection.

I noticed this in my practice and moved all SIJ injections, genicular and SIJ blocks to our procedure room for IA hip injections and peripheral joint arthrograms etc, so our practice doesn’t waste ASC resources on procedures not paying ASC facility fees.

This is not correct, our ASC gets facility fees on Medicare, Medicaid , and private insurers for SIJ injection, I was was on Billing audit committee for 2 yrs there.
Things that don't get reimbursed are not allowed at our ASC.

 

[bedrock]

This is not correct, our ASC gets facility fees on Medicare, Medicaid , and private insurers for SIJ injection, I was was on Billing audit committee for 2 yrs there.
Things that don't get reimbursed are not allowed at our ASC.

Have you checked on payments for this year? Things change.

 

[Nodolor]

Have you checked on payments for this year? Things change.

They still were paying in August, when I last worked there.