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Facet and SI Injection w/ Fluoro

  1. #1
    Default Facet and SI Injection w/ Fluoro
    Medical Coding Books
    I have an MD who is doing a lumbar facet injection and a Sacroiliac injection both with fluoroscopic guidance. Can we bill separately for the fluoro for the SI injection?
    Missy Heuer CPC, CIRCC, CANPC

  2. Default
    Since the flouro is considered a component of the facet joint, I would say no. I have been billing this same scenario without flouro. I have yet to see whether my payers will deny the si joint injection for the absence of the flouro code... I'm hoping not.

  3. Default
    wait, why can't you bill fluro. with the SI joint? you should be able to. The fluro is inclusive with 6449x but not with 27096

  4. #4
    Default Fluoro w/ si injection
    I agree, you should be able to bill the fluoro with the SI injection but check with your Carrier. I know ours has language that without the fluoro, the SI isn't considered medically necessary. You might need to put a -59 on the fluoro (again, check with Carrier) so that they don't kick it out thinking you're trying to bill it for the facet.


  5. #5
    My carrier prohibits doing any kind of SI or ESI injections at the same encounter as facet injections. I would look at your LCD very carefully.
    Walker Bachman, CPC, CPPM

  6. Default
    All valid points. I'm also concerned that my SI joints aren't going to pay because of it. My rationale is that flouro is not a per level or per body region service, and since it is now considered a component of the facet injections you would not be able to bill it seperately. If you did bill all these, facet joints, SI joint and flouro on the same claim I have no doubt that at least one of them would be denied, though it's anyone's guess which code. The best option, in my opinion, is to schedule these two procedures on different days.

  7. Default
    I disagree, fluro is per spinal region, see below article from the American Academy of Pain Mgt.

    When reporting code 77003, it is important to recognize that it should be reported once per spinal region. Since the cervical and thoracic regions are two separate regions, code 77003 can be reported once for each region. Likewise, it can be reported twice when guidance is required for procedures performed in the lumbar and sacral regions. It would not be appropriate, however, to report code 77003 more than once when the guidance is at C7-T1, T12-L1, or L5-S1 junctions. In these instances, the 77003 is reported only once.

    CPT guidelines indicate you should report the most specific code for the service provided. Therefore when guidance is used in conjunction with pain medicine injection procedures, codes 77002 and 77003 should be reported instead of code 76000 (Fluoroscopy (separate procedure), up to one hour physician time) as they more accurately describe the service rendered.

  8. Default
    Thanks bfaithful. I stand corrected ;-) sheepish.

  9. #9
    St. Joseph County, Indiana
    Nice job bfaithful.

    I haven't had to worry about cervical and lumbar fluoro in the same session for a long time, but your info is nice to have just in case.

    Is there a link or how can I get my hands on this directly?

    Brock Berta

  10. #10
    North Carolina
    I just happen to have this link at the tip of my fingers (since we perform these also)

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