Anesthesia Coding Alert

Question: The anesthesiologist who performs nerve blocks for pain management says I should use 27096 (injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid) for the following procedure:9 cc of anesthesia and 40 mg of a steroid are injected in the joint space. Then the remaining 8 cc were injected into the superficial sacroiliac ligaments. Should I use his suggested code, one from the 64400 series, or both? It is causing payment problems when I bill his code; I am only receiving reimbursement under ambulatory payment classifications (APCs) for the injection materials.

New Jersey Subscriber  
Answer: If the injection was performed in the facet joint of the spine, a code from the 64470-64476 series (various levels and locations for injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve) would be appropriate. Use 27096 only for the sacroiliac joint injection.
 
It seems as if the physicians documentation may be questionable, or at least may not be clear enough for you to code accurately from. If you have questions about the procedure, ask the physician and possibly suggest that he change his wording when dictating or making chart notes so the explanation is easier for you to code correctly. If the injections are performed in an ambulatory surgery center (ASC), that could be part of the payment problem. For a time, Medicare was not paying for nerve blocks in ASCs; ask your local carrier if thats the case in your area.
  Answers to Reader Questions and You Be the Coder provided by Kathy MacDonald, billing supervisor with the physician group Norwalk Anesthesiology in Norwalk, Conn.; Scott Groudine, MD, an anesthesiologist in Albany, N.Y.; and LaSeille Willard, CPC, lead biller with Anesthesia Consultants in Frederick, Md.