# Facet and SI Injection w/ Fluoro



## missyah20 (Mar 5, 2010)

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?


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## hgolfos (Mar 5, 2010)

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.


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## BFAITHFUL (Mar 5, 2010)

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


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## NIENAJADLY (Mar 8, 2010)

*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.

Kellie


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## Walker22 (Mar 8, 2010)

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.


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## hgolfos (Mar 9, 2010)

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.


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## BFAITHFUL (Mar 10, 2010)

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.


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## hgolfos (Mar 17, 2010)

Thanks bfaithful.  I stand corrected ;-)  sheepish.


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## brockorama01 (Mar 23, 2010)

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


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## RebeccaWoodward* (Mar 23, 2010)

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

http://www.painmed.org/pract_mngmnt/coding_tips.html#fluroscopy


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## hgolfos (Mar 23, 2010)

Thanks Rebecca!  I appreciate the link.


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## dwaldman (Mar 23, 2010)

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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