Anesthesia Coding Alert

Question: Which modifier should we append for Medicare claims when 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) is performed in conjunction with 20600* (Arthrocentesis, aspiration and/or injection; small joint, bursa or ganglion cyst [e.g., fingers, toes]), 20605* (& intermediate joint, bursa or ganglion cyst [e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa) or 20610* (& major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa])?

Florida Subscriber

Answer: The appropriate modifier for 76003 will depend partly on the situation and on your Medicare carrier. One possibility is that the carrier may want modifier -26 (Professional component) if the physician uses equipment belonging to the hospital or surgical center. Call your local Medicare representative for guidance, and try to get the information in writing so you'll have backup in case the procedure is still denied.