The below can be found in AMA CPT Assistant Sept 2004. The reason I am sending to the AMA for clarification is if the SI joint is in the sacral region and an intralaminar injection is at lumbar region, technically you would span two spinal regions so would they consider reporting 77003 in conjunction with an epidural and a code such as 27096 were the fluoroscopy is valued and included in the code.
Coding Tip
Code 76005 is intended to be reported per spinal region (eg, cervical, lumbar) and not per level.
Below is the question that I plan to send to NCCI to have both the NCCI/CMS and AMA perspective:
National Correct Coding Initiative
Correct Coding Solutions LLC
P.O. Box 907
Carmel, IN 46082-0907
Attention: Niles R. Rosen, M.D., Medical Director and Linda S. Dietz, RHIA, CCS, CCS-P, Coding Specialist
After reviewing the below statement in chapter 9 in the NCCI policy manual, I was inquiring about when a sacroiliac joint injection in the sacral region is performed with fluoroscopy (27096) at the same encounter as lumbar intralaminar injection (62311) at L5-S1 with fluoroscopic guidance (77003). Would it be appropriate to add modifier 59 to 77003 since the fluoroscopic guidance was utilized for the performance of the lumbar epidural at a separate site in addition to the sacroiliac joint injection that also requires fluoroscopy. Since fluoroscopy is only reported once per session, how does this concept apply when there is a code that includes and requires fluoroscopy performed in the same encounter as a code that fluoroscopy is separately reportable?
3. CPT codes 76942, 77002, 77003, 77012, and 77021 describe radiologic guidance for needle placement by different modalities. CMS payment policy allows one unit of service for any of these codes at a single patient encounter regardless of the number of needle placements performed. The unit of service for these codes is the patient encounter, not number of lesions, number of aspirations, number of biopsies, number of injections, or number of localizations.