Orthopedic Coding Alert

Although many coders argue that fluoroscopy should never be billed separately from injection procedures, there are circumstances when orthopedic practices should appeal denials and fight for their rightful reimbursement. When to Bill Fluoro for SI Injections Fluoroscopic guidance (76000-76005) is a must for many orthopedic injections, but the Correct Coding Initiative (CCI) bundles fluoroscopy into most injection procedures. Because 27096 (Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid) includes arthrography in its descriptor, many coders believe they should not separately report radiological supervision or fluoroscopic guidance. The arthrogram should be billed separately, however, and if the orthopedist does not perform arthrography with the injection, practices can bill fluoroscopy in addition to 27096. CPT Assistant clarified the various codes that can be submitted with 27096, advising coders to use 73542 (Radiological examination, sacroiliac joint arthrography, radiological supervision and interpretation) "for the radiological supervision and interpretation associated with sacroiliac [SI] joint arthrography." Because fluoroscopic guidance is included in 73542, you should not report fluoroscopy separately when an arthrogram is performed. Therefore, an SI injection with arthrography and fluoroscopy should be billed as follows: 27096 73542. In some cases, the orthopedist does not perform arthrography or issue a formal radiologic report with SI injections, but still uses fluoroscopy to identify the appropriate injection site. In these instances, you should not report 73542, but you can bill separately for the fluoroscopy with 76005 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, transforaminal epidural, subarach-noid, paravertebral facet joint, paravertebral facet joint nerve or sacroiliac joint], including neurolytic agent destruction). Consequently, an SI injection with fluoroscopy, but without a formal arthrography, would be billed as follows: 27096 76005. If your carrier denies fluoroscopy claims billed with 27096, appeal the denials with a copy of the CPT reporting guidelines (listed under the 27096 code descriptor in the CPT manual) along with a copy of your operative report to demonstrate medical necessity for the fluoroscopy and as proof that you did not perform an arthrogram with the injection. Hip Injections Include Fluoroscopy Hip injections often require as much precision as SI injections. Therefore, orthopedists frequently use fluoroscopy to correctly identify the site. In fact, a comment in CPT following 20610* (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa) advises, "If imaging guidance is performed, see 76003, 76360, 76393, 76942." But coders report constant denials when billing 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) with 20610. This occurs because CCI bundles 76003 into most injection procedures, including joint injections, says Trish Buskauskas, CPC, the chief executive officer of TB Consulting, a coding and reimbursement consulting company [...]