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Thread: G0260

  1. #1
    Join Date
    Apr 2007
    Posts
    56

    Default G0260

    I am billing for an ASC for G0260. Medicare cam back stating the procedure code is inconsistent with the modifier used. It was billed G0260-50 an 77003-TC with diagnosis codes 720.2,722.52.
    PROCEDURE:
    1. Left sacroiliac joint injection intraarticular.
    2. Right sacroiliac joint injection intraarticular.
    3. Fluoroscopic guidance for precise needle placement lumbar spine arthrogram.

    HISTORY: The patient is a 75-year-old gentleman who was seen in the clinic in consultation. He is status post fusion to L5. He has pain in his low back consistent with sacroiliac mixed pain with L5-S1 facet arthralgia. We will proceed with sacroiliac joint injections today, evaluate his pain over the next month and consider workup for L5-S1 medial branch block.

    DESCRIPTION OF PROCEDURE: He was placed prone on the fluoroscopy table and monitored with blood pressure and pulse oximetry by an RN. No sedation was given. Fluoroscopic imaging was used throughout to aid in precise needle placement and allow for an epidurogram. A 25-gauge 3 1/2-inch needle with a slight curved tip was used to advance under barrel-view technique, rotated slightly and curved into the cephalad portion of the joint. Then 0.5 cc of Isovue showed filling into the joint space; however, there was not very good spread through the capsule. Then 0.5 cc of 0.75% bupivacaine and 80 mg of triamcinolone were injected slowly. The patient tolerated the procedure well and will follow up with a report in one week.

    Thanks,
    Jenny

  2. #2
    Join Date
    Apr 2007
    Location
    ENGLEWOOD/DENVER
    Posts
    2,339

    Default

    per Medicare guidelines, you should use rt/lt not 50 in an ASC

    G0260-RT
    G0260-59-LT
    77003-TC (non payable N1 payment indicator)

    Hope this helps
    Mary

  3. #3
    Join Date
    Apr 2007
    Posts
    56

    Default

    Mary,

    Thank you so much.

    Jenny

  4. #4

    Default

    You don't need the 59 mod, just RT LT. Medicare does not accept the 50.
    Also the 77003 should be GY TC modifiers.
    Andrea

  5. #5
    Join Date
    Apr 2007
    Location
    Philadelphia, PA
    Posts
    92

    Smile g0260!!

    Hi

    The same thing is happening to our claims w/Medicare. They are bouncing out all of our SI injections using RT/LT mods w/dx of 720.2! I have checked and double checked our LCDs and nothing states that criteria for billing has changed! Im in Pennsylvania, does anyone out there happen to have this problem and/or know why it is happening? Thanks, Susan

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