Anesthesia Coding Alert

Question: My anesthesiologist performed two postprocedure injections on a patient. Can I bill 62311 with 27096? If not, should I bill one code in favor of the other?

North Carolina Subscriber

Answer: While performing 62311 (Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]) together with 27096 (Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid) is rare, the Correct Coding Initiative (CCI) edits show that you may unbundle them with a modifier.

If you were to unbundle this pair, you need to append modifier 59 to 62311, because it is the column 2 code (the component code) to the more comprehensive code, 27096.

Note, however, that due to the rarity of these two codes being indicated/performed together, your documentation for proving medical necessity will have to be very clear.

Also note that this kind of procedure is performed for post-operative pain and is considered a surgical procedure. You shouldn't use any anesthesia crosswalk codes.