Wiki 77003-26 bundling

[Jennifer Moore]

Can anyone help me with billing the following codes: 62311, 27096 -59, & 77003 -26. 27096/77003 -26 are bundled, but I am billing 62311/77003 -26 together, if anyone is getting payment please help me with the coding of these CPT codes.


Thanks,
Jennifer

 

[dwaldman]

Code 62311 is a component of Column 1 code 27096 but a modifier is allowed in order to differentiate between the services provided.

Code 77003 is a component of Column 1 code 27096 but a modifier is allowed in order to differentiate between the services provided.

After running a CCI check, I saw that they have bundled the epidural and fluoro into the SI Joint block. In order to relay that imaged-guided njection into thelumbar/caudal epdiural space is separate from the image-guided SI joint block, the following modifiers would be required:

27096
62311-59
77003-26 59

Would want to check any local coverage determinations policy for your Medicare carrier and determine they do not have a statement as seen below from WPS Medicare J5. If they do have a statement as such, would need to review this with the physician for future procedure selection in a single encounter.

"Accordingly, providing a combination of epidural block, facet joint blocks, bilateral sacroiliac joint injections, lumbar sympathetic blocks or providing more than three levels of facet joint blocks to a patient on the same day is considered not reasonable or necessary. Such therapy can lead to an improper diagnosis or unnecessary treatment."