Eli's Rehab Report
Append -59 for Two Fluoros
PDF
Florida Subscriber
Answer: Depending on your payer, you may be able to report the second fluoroscopy session, but you should append modifier -59 (Distinct procedural service), not modifier -76 (Repeat procedure by same physician), to the fluoroscopy code.
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 you should ask your carrier whether it maintains specific guidelines for this service. 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.
Link the above CPT codes to the ICD-9 code that necessitated the epidural injection. Then report the remaining two codes as follows:
27096 Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid
76005-59.
Remember to link these two CPT codes to the diagnosis code that necessitated the SI injection.
Eli's Rehab Report
- Reporting 64405 for Third Occipital Nerve Blocks? Think Again
Physiatrists who administer third occipital nerve blocks should not automatically assume that 64405* (Injection, anesthetic [...] - Take 3 Steps to Fewer Modifier -25 Denials
If you can prove that you've met specific documentation requirements, you can report both a [...] - News Brief:
Medicare Implements $1,590 Therapy Cap
Effective July 1, 2003, CMS will implement a $1,590 annual cap on Medicare B outpatient [...] - You Be the Coder:
Limited or Single-Extremity EMG?
Question: My physiatrist circled 95860 on an electromyography (EMG) report. His EMG dictation states, Vastus [...] - Reader Question:
Even Observation Patients Require H&P
Question: Our physiatrist admitted a patient as observation status. He handwrote a history and physical [...] - Reader Question:
Append -59 for Two Fluoros
Question: Our physician performed fluoroscopy for a transforaminal lumbar epidural steroid injection, and later used [...] - Reader Question:
Medicare: Partners Are Same Physician
Question: One of our physiatrists administered a Botox injection (64614) to a patient with cerebral [...] - Reader Question:
Report 2 Codes for Polyneuropathy, AIDS
Question: One of our patients has polyneuropathy of the extremities due to AIDS. The physiatrist [...] - Reader Question:
Modifier -50 Is Carrier-Specific
Question: When we perform bilateral procedures, should we bill the procedure code twice, with modifier [...] - Reader Question:
Diagnoses Dont Dictate Consults
Question: An internist requested a consult from our physiatrist for a patient with a confirmed [...]