Orthopedic Coding Alert

Question: Our physician performed fluoroscopy for a transforaminal lumbar epidural steroid injection, and later used fluoroscopy again with a sacroiliac (SI) joint injection. Our office manager said that we should append modifier -76 (Repeat procedure by same physician) to the second fluoroscopy code. Is this accurate?

Florida Subscriber

Answer: Depending on your payer, you can most likely report the second fluoroscopy session, but you should append modifier -59 (Distinct procedural service) to the code instead of modifier -76. According to the May 2001 CPT Assistant, "Modifier -76 is intended to describe a 'reoperation,' rather than performing the same procedure at multiple sites." Because you administered separate types of injections, carriers would not consider the second procedure a "reoperation."
 
Some insurers will deny a second fluoroscopy session, so check with your carrier to determine whether it maintains specific guidelines on this topic. If your payer does not maintain a "fluoroscopy only once per day" rule, your claim should read as follows:

  64483 Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level 

  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.
 
You should link the above CPT codes to the ICD-9 code that necessitated the epidural injection.

  27096 Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid

  76005-59.
 
Link these two CPT codes to the diagnosis code that necessitated the SI injection.