Wiki ESI/TF ESI mofider

[nan.coder]

Our pain managment physician often performs lumbar transforaminal ESI (64483) and interlaminar ESI (62311) at different levels. The interlaminar ESI is being reported with a
-59 modifier because it is the lower priced procedure.

An auditor said the -59 modifier should be attached to the transforaminal ESI because the interlaminar injection bundles the transforaminal and not vice versa.

Does anyone have insight for this situation?

Thanks

 

[mhstrauss]

Our pain managment physician often performs lumbar transforaminal ESI (64483) and interlaminar ESI (62311) at different levels. The interlaminar ESI is being reported with a
-59 modifier because it is the lower priced procedure.

An auditor said the -59 modifier should be attached to the transforaminal ESI because the interlaminar injection bundles the transforaminal and not vice versa.

Does anyone have insight for this situation?

Thanks

Yes. The NCCI edits spreadsheet has 62311 listed as a Column 1 code to 64483, Column 2 code. If documentation supports the use of 59, it always goes on the Column 2 code. Here's the link to the NCCI edits page if you need it:

http://www.cms.gov/Medicare/Coding/...ect=/NationalCorrectCodInitEd/NCCIEP/list.asp

Hope this helps!