Wiki 27096 & 64484

[dsmith03@hotmail.com]

Can anyone explain to me why as of April 1 these two codes are now considered bundled and cannot be reported together. 27096 is a sacroiliac injection.64484 is an additonal injection (add on code) to lumbar or sacral levels of the back. Completely different body parts. The primary procedure to 64484 has no such conflicts.

 

[CodingKing]

64483 does have a conflict w/ 27096 but modifier will bypass when appropriate. The add-on for some reason doesn't allow modifier to bypass for 64484 to 27096

 

[vnsconsultants]

For some reason???

64483 does have a conflict w/ 27096 but modifier will bypass when appropriate. The add-on for some reason doesn't allow modifier to bypass for 64484 to 27096

I have a really hard time with this answer. 64483 & 64484 are the same code (one the primary level & the other the add-on code)

Why would the primary level be considered separate with modifier when reported with 27096 but the add-on for additional levels of the same TF ESI are considered inclusive and not separately reportable with modifier?

I do not understand.

 

[MI_CODER]

This is what I think is going on. The reason that there is an edit between 64484 and 27096 and no modifier can be permitted is because you can only report 64484 with 64483. If you're reporting 64484 (only) with 27096 then this is automatically going to get denied because 64484 is an add on code and can only be reported with 64483.

If your provider is doing separate injections and the documentation supports the use of 27096, 64483 and 64484 then I would use modifier 59 on 64483 and 64484. I'm assuming this isn't going to get denied because you have your parent code. If it does get denied then I would fight it if your documentation clearly shows that these are separate injections.

 

[vnsconsultants]

"If you're reporting 64484 (only) with 27096 then this is automatically going to get denied because 64484 is an add on code and can only be reported with 64483"

That's not what's going on according to the NCCI edits.
From AAPC CCI Edit Checker:
"Code 64484 is a column 2 code for 27096, These codes cannot be billed together in any circumstances.
Code 64484 is bundled into code 27096 Code 64484 cannot be billed with 27096.
CCI edit Rule:
Misuse of column two code with column one code"

The NCCI edits show suprascript "0" for 64484 when reported with 27096. It's saying the codes can't be billed together in ANY circumstances... not even when reported with 64483. I think it's a limitation by the carriers on ESI injections due to medical necessity. I think they're curbing how many levels / types of injections can be done at once. It's in total conflict with the NCCI edits that existed before. I've gotten to the point where if we did enough levels of TF ESI, I don't even report the SI Joint Injection because I just know it will cause exhausting denials that will never be paid because the carriers can simply say "See NCCI Edits" and not pay for all the services. I also told my neurosurgeon to stop performing these this way due to the edits... but y'all know how that goes. lol


ALSO: RELATED QUESTION - - Why does NCCI edits show 64483 is inclusive to 27096 when 64483 is the CPT with the HIGHER RVU? Shouldn't 27096 be inclusive to 64483 since it has the LESSER RVU?