Wiki Fluoroscopic guidance - Doctor used codes

[dgiretto]

Doctor used codes 27096x2, 62311 and 77003. He attached a modifier 59 to the 27096. It passed through their edits and was paid. Now they are requested a refund on the 77003. The letter I've received states fluoroscopy included in 27096, which is true. But it isn't included in the 63211. I have searched the internet for information about billing these codes together and have been unsuccessful in finding anything. As these are two separate procedures why are they requesting the refund for the 77003? Are we only allowed payment of 77003 once per day? Before I do request any refunds I want to make sure their reasoning is correct.

 

[dwaldman]

It would be important to contact NCCI to determine when modifier 59 is appropriate with the code pair 27096 & 62311 or if the carrier has specific instructions prohibiting multiple interventions in the spine to be performed during the same encounter.

 

[lyndalennon]

27096 needs a modifer

FYI for the code 27096 is a unilateral procedure. For bilateral procedure, use modifier 50