Wiki Billing Bilateral Sacroiliac Joint Injections

[HCOLLINS25]

I have a coder in my office that is saying we should be billing the SI bilateral injections to Medicare with G0260 with QTY 2 and no 50 modifier? For as long as I have been billing/coding we have billed bilateral Joint injections with the 50 modifier and QTY 1 and they were processed correctly. I am being told that they have recently changed the coding guidelines and the correct way is to bill with no modifier and QTY 2, Is this information correct or I am assuming our in office coder is trying to seek for more reimbursement instead and that is not correct. Any advice or info is appreciated. Thanks

 

[amyjph]

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=59246

https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39475

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=59257

ASC facility claims (specialty 49) report bilateral procedures on two separate lines, with one unit each. Modifiers -LT and -RT are appended to each line. ASC facilities should not report modifier 50. Professional services performed in the ASC should continue to report bilateral procedures with modifier 50.

 

[jkyles]

I have a coder in my office that is saying we should be billing the SI bilateral injections to Medicare with G0260 with QTY 2 and no 50 modifier? For as long as I have been billing/coding we have billed bilateral Joint injections with the 50 modifier and QTY 1 and they were processed correctly. I am being told that they have recently changed the coding guidelines and the correct way is to bill with no modifier and QTY 2, Is this information correct or I am assuming our in office coder is trying to seek for more reimbursement instead and that is not correct. Any advice or info is appreciated. Thanks

Hi there, if you're performing the injections in office you will not use G0260. It could be that your office coder is confused by the March update to SI joint interventions, so I wouldn't assume that they are just trying to get more money.