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Thread: Facet and SI Injection w/ Fluoro

  1. #11


    AAPC: Back to School
    Thanks Rebecca! I appreciate the link.

  2. #12
    Join Date
    Apr 2007


    Our old WPS Medicare LCD for Facets before fluoro was included stated that 77003 should be only reported once per procedure. Their view point is that the definition for 77003 says ".....injection procedures" and they considered this was plurual meaning that this would encompess all the procedures performed utilizing fluoro under listing 77003 once. Now this wording is no longer their under coding and billing attachment. But knowing their stance on 77003, and in my particular situation I would not list 77003 separatley if an Si and facet injection were performed in the same setting. I notice that some of the commercial carriers follow the CCI Edits up to the point where their software should be able to know that modifier is allowed for this code pair. I have seen denial where yes these two codes have a CCI Edit but the commercial carrier is not going to recognize the modifier when they should. Could this happen ;for example, trying to bill 64493 27096 77003 26 59. I guess you would have to look at past LCDs for your Medicare carrier to see their guidelines on billing 77003, if you bill 27096 without 77003 will it deny with a code that already requires it, and will the commercial carriers separately reimburse it and follow the fact the 59 would be allowed.

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