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Anesthesia Coding Alert

Reader Questions:

Find the Fee for Bilateral 27096

Published on Mon Mar 08, 2010

Question: We had a patient who was given bilateral sacroiliac joint injections. Our pain management specialist usually doesn't perform bilateral procedures, so I'm not sure about the correct coding or billing. Where can I find a fee schedule in order to bill this at a reasonable fee? Oregon Subscriber Answer: The 2010 Medicare national allowable rate for a single unit of 27096 (Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid) is $167.79 in an office site of service and $68.56 for a facility site of service. Medicare processes bilateral procedures at 150 percent of the allowable rate for a single procedure, which translates to $251.69 for an office site and $102.84 for a facility site. When you factor in modifier 50 (Bilateral procedure), most providers just double their fee for a single injection reported twice, and understand there will be an additionalwrite-off for the bilateral procedure reduction. Many payers follow [...]
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