Wiki CCI Edit with 27095 and 64483

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jaimevanstaden04@yahoo.com

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Can someone help me understand the rational of this NCCI bundling Edit?

27095 64483 20090401 * 0

27095 is Injection procedure for hip arthrography; with anesthesia
64483 is Injection, anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level

The physician injected the hip and it is linked to a hip pain dx, the physician then injected L5-S1 and it is linked to lumbosacral neuritis dx.

Because the two injections are in separate locations for different dx the physician feels he should be reimbursed however the insurance is denying for this NCCI edit. Can anyone offer suggestions on fighting this with the insurance or assist in me explaining w/rational to my physician why this is not allowed?! We have already requested reconsideration based on the different dx and the insurance has kept with the original decision to deny.

Thanks!
 
I hate to answer this way but IDK. I have taken over his billing and this is how he always bills this procedure. This is how he dictates the hip injection.

Using the C-arm fluoroscope for down-the-beam guidance and coming from a direct posterior approach, a bent-tip 22-gauge spinal needle was advanced until it contacted the neck of the femur near the articular surface. Isovue-M 300 was injected with realtime fluoroscopic interpretation. There was good spread of dye in the joint space and no intravascular leakage. 40 mg of triamcinolone mixed with 4 cc of 0.5% bupivacaine were injected, and the needle was withdrawn. The patient tolerated the procedure well and was in good condition when he went to the recovery area.
 
This is what would be documented for CPT 27095 which is done with anesthesia:
Under fluoroscopic guidance, a needle is inserted into the joint cavity (hip, shoulder, ankle, sacroiliac, wrist, etc.). Once the position of the needle is confirmed, the physician injects the contrast material (it can be either dye alone, or both dye and air for what is called a "double?contrast arthrogram"). Then the physician removes some of the joint fluid and sends it to laboratory for analysis. The needle is then removed.
I think you need to speak with your physicain about what procedure he is really performing.
 
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