Anesthesia Coding Alert

Question: I've seen conflicting reports about whether CCI edits have bundled 76005 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint], including neurolytic agent destruction) with 27096 (Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid). Which is correct?

Florida Subscriber

Answer: Last year CCI bundled 76005 and 27096. Medicare later reversed the edit so modifier -59 (Distinct procedural service) was required to override the edit. The new policy was effective Oct. 1, 2001, and was retroactive to July 1, 2001. So, you can bill 76005 and 27096 with modifier -59, if you have adequate documentation of the situation. List 27096 (seven base units [BUs]) first and 76005 (two BUs) with -59 appended because 27096 is the higher-valued procedure. Remember that if you do not own the fluoroscopy equipment, you should also append modifier -26 (Professional component).