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Anesthesia Coding Alert

Reader Questions:

Confirm Modifiers for 76005 in Surgical Facility

Published on Wed Aug 16, 2006

Question: What modifiers should I report with 76005 and 72275 in a surgical facility? Medicare says our procedure code is inconsistent with the modifier used, or that a required modifier is missing. 


Texas Subscriber
  

Answer: Include modifiers TC (Technical component) and SG (Ambulatory surgical center [ASC] facility service) if you submit claims for the facility.

Medicare does not pay for some radiology procedures when physicians perform the service in an ASC. Your carrier's ASC-approved list may not include codes 76005 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint], including neurolytic agent destruction) and 72275 (Epidurography, radiological supervision and interpretation).
 
Another problem could arise if the physician performs the fluoroscopy and epidurography during the same session. CPT includes a note stating 72275 includes 76005, so you shouldn't submit both codes. 
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