A while back
NSN
was doing a review for a facility where Sacroiliac Joint (SI) injections were being performed. There are two ways you can code for an SI joint injection, code
27096
or
G0260
- 27096 (Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed)
- G0260 (Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography)
G0260
was created by Medicare for the ASCs to bill for the facility charge of SI joint injections. Typically if it is a commercial insurance you use
27096,
however, some commercial insurances adopted the code
G0260
as well. Some actually only accept
G0260
because they follow Medicare fee schedule or they only accept
27096
. It is a matter of knowing which one they accept.
While doing a review of a facility's Payer contracts it was discovered a particular commercial insurance
allowed for both
27096
and
G0260
.
There was a difference in allowed of
$927 for 27096 and $2,223 for G0260
. With this being a commercial insurance, the CPT
27096
had been billed in the past. With a
$1,296
difference in allowable, corrected claims were done on 37 cases bringing in an
additional $47,952 of reimbursement for this facility.
This is a great example to show how important it is to be familiar with your contracts,
don't leave money on the table
!
