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calif work comp pain billing

  1. #1
    Cool calif work comp pain billing
    Medical Coding Books
    I have a question regarding work comp billing on SI joint injection coding. I am coding with cpt 2709677003. Claims are denied and our work comp biller says that they use(pay) cpt 27093 for these injections. I realise that California work comp is slow on updating these codes but is this correct to bill this way?
    Any help would be greatly appreciated.
    Thanks Diann Do Bran CPC, CPC-H

  2. #2
    Sioux Falls South Dakota
    Well, SI is 27096, while 27093 is hip. I am in a different state - but every state has their work comp rules somewhere on their web site, accessible to all. That should also include their fee schedule. I would go out and look at that and see if code 27096 is on there - it's been a code since 01/01/2000, and most W/C carriers aren't that far behind.

    It could be that they are not recognizing your 77003 for the fluoro guidance - it was effective 01/01/2007, and we had problems with W/C until 2009 with that one. Also, if done at the hospital, are you putting your 26 modifier on the 77003?

    I hope this helps - no hard and fast answers, but hopefully somewhere to start.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  3. #3
    Columbia, MO
    you need to go to CA work comp web site for providers, there you will find the work fee schedule for CA. They will pay only for the codes on that fees schedule. If you look real close it states which version of CPT it is based on, when I last worked with a CA client on this was 2 years ago and I believe it was 1996. Any code not it that code set will not be accepted. We had to get a CPT book from the same year as the fee schedule and from there on out it was smooth sailing.

    Debra A. Mitchell, MSPH, CPC-H

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