Sacroiliac Joint Injections

ksoutherland

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Our clinic recently acquired a Pain Management doc and I am having trouble with some of the coding and billing..I need help! The doc did sacroiliac joint injection (CPT 27096) in our hosptial outpatient surgery. I am trying to bill the professional fee...the patient has Medicare and the I received a denial for 27096 stating "the related or qualifying claim/service was not identified on this claim". The injection was done with fluro imaging which the hospital billed with CPT 76000....Should I be using a different code or a modifier?
 
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You have to bill a 27096 with a modifier of 50, rt, or lt depending on the side it was done. Medicare has specific LCDs for this procedure. For 2012 the fluoro code is included in the 27096 CPT. Hope this helps.
 

mhstrauss

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I agree with billingchic. But if the procedure was done in 2011, the correct fluoro code should be 77003, not 76000 (this is stated below the code description for 27096 in parentheses). We have always billed 27096, 77003-26 for our physicians with no problems.

Hope this helps! :)
 

dwaldman

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For the denial you received, I believe that you stated 27096 denied. Might want to contact the Medicare carrier you are billing about that denial, they might of previously set up their claim processing software to require 77003 to be billed with 27096 prior to 2012 and have not updated their system. But calling could rule that out.

Below is from AMA CPT Changes 2012

Rationale
Injection code 27096 has been revised to include image guidance (fluoroscopy or CT) and arthrogrphy when performed. The first parenthetical note following code 27096 has been updated to indicate that code 27096 is to be used only with CT or fluoroscopy imaging confirmation of intra-articular needle positioning. An instructional note has been added to indicate that code 20552 should be reported if CT or fluoroscopy imaging is not performed. In support of these changes, the second and third cross-reference notes following code 27096 have been deleted from CPT 2012 and several changes were made to the Radiological section.
 

jacquien

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Is a modifier needed for 27096

Our SI Injections are being denied by NY Medicare stating that a "required modifier is missing". Is anyone familiar with this carrier and can tell me what modifier they are asking for?

Thanks!
 

capricew

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27096 is not on medicares approved list of procedures for outpatient facilities. The physician would report 27096-26, however the facility should report G0259 or G0260 depending on which is most appropriate per the operative note.
 

mhstrauss

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We perform these procedures in the outpatient setting, and the only modifiers we've used in the last year-ish are RT/LT or 50, and haven't had any problems with any payer. Our MAC is Pinnacle...not sure if this helps you or not... :confused:
 

mitchellde

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27096 is not on medicares approved list of procedures for outpatient facilities. The physician would report 27096-26, however the facility should report G0259 or G0260 depending on which is most appropriate per the operative note.
There is no reason to use the 26 on a 27096 this code does not have two different components if there is a G code that is the same descriptor as the CPT code then for Medicare you use the G code physician and facility. i am not familiar with these G codes. I have always used the 27096 code with no issues.
 

dwaldman

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"HCPCS code G0260 (sacroiliac joint injection of anesthetic agents or steroids) was added to the list of approved ASC procedures for services performed on or after July 1, 2003 (CMS-1885-FC, 3/28/03). Therefore, when a therapeutic sacroiliac joint injection is administered to a Medicare beneficiary at an Ambulatory Surgical Center, it should be reported by the ASC as HCPCS code G0260."

HCPCS code G0260, however, is not payable under the Medicare Physician Fee Schedule (MPFS).

https://www.cms.gov/MLNMattersArticles/downloads/MM2979.pdf

Above it describes G0260 being reported for freestanding ASC.

On the hospital fee schedule 27096 has B status indicator with no payment
G0259 has N status indicator with no payment. Similiar to a freestanding ASC, a hospital has to report G0260 for SI joint block with fluoroscopy or CT

G0260 falls under APC 207 with a status indicator T with payment allowed.

http://www.cms.gov/HospitalOutpatientPPS/AU/list.asp
 
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