MEDAC BILLING & COMPLIANCE ALERT
October 23, 2009

By Bellinger P. Moody, RHIA, CPC, CCP
Executive Vice President of Compliance

NC Medicare Bundles Fluoroscopy Service With Facet Joint Injections/Denervations & SI Joint Injections:  Other Medicare Contractors Likely To Follow

Effective for dates of service performed on or after September 15, 2009, NC Medicare will no longer separately pay for Fluoroscopy (CPT code 77003-26) when performed in addition to Paravertebral Facet Joint Nerve Blocks/Denervation and Sacroiliac Joint Injections.
This new NC Medicare policy (LCD# L30168) only applies to providers in North Carolina.  However, I anticipate that other state Medicare payers/contractors will follow.  The policy specifically states, in reference to Facet Joint injections/denervations & therapeutic SI joint injections:

“The RVUs for radiologic guidance are included in the procedure, and fluoroscopic guidance (77003) should NOT be billed separately”.  (In addition to facet joint injections & facet joint denervations).

“Fluoroscopic or CT guidance ensures optimal access to the SI joint space in diagnostic procedures but may not be necessary for therapeutic procedures."

Therefore, NC Medicare will no longer separately pay for Fluoroscopy when billed in addition to the following CPT codes:  64470, 64472, 64475, 64476, 64622, 64623, 64626, 64627 and CPT code 27096 (SI joint injection when done for therapeutic purposes, i.e. steroid injected into SI joint for immediate and potentially lasting pain relief).

You may read this policy in its entirety at the following web site address:
www.cms.hhs.gov/MCD/viewlcd.asp?lcd_id=30168&lcd_version=6&show=all.

As a result of this new policy, if you are a North Carolina provider and you mark Fluoroscopy separately in addition to one of these procedures on your billing documents, we will not bill it to NC Medicare.

The information presented herein reflects general information that is current as of the date it is first published.  In light of changes that may occur in the health care regulatory and compliance environments, the author's presentation of this information and any general advice previously published might become outdated.  Please check with your individual legal and/or compliance advisor(s) prior to taking any significant actions based upon the information and advice presented.