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G0260 Billing

Amani Posted Wed 28th of August, 2013 20:04:21 PM

if the provider did the right and left side injection for sacroiliac joint, how you can bill G0260? per Medicare MUE=1.

SuperCoder Answered Thu 29th of August, 2013 11:40:12 AM

The CPT code 27096 has a bilateral surgery indicator of "1." Thus, it is considered a "unilateral" procedure. Follow the same guidelines for G0260:
When injecting a sacroiliac joint bilaterally, file with modifier –50.
When injecting a sacroiliac joint unilaterally, file the appropriate anatomic modifier –LT or –RT.
Only one (1) unit of service (equals one bilateral injection or one unilateral injection) should be submitted for a unilateral or bilateral sacroiliac joint/nerve injection.
CPT code G0260 should be billed by facilities paid by OPPS.

Amani Posted Thu 29th of August, 2013 12:31:38 PM

so if I have 2 lines on the claim:
Line 1: G0260 1 unit
Line 2: G0260 1 unit

Do I pay both lines? or should I deny the second line? or should I pay the second line 50% of ASC? How the provider should bill this? and if he billed G0260 with modifier 50, do I pay 150% of ASC fee schedule?

SuperCoder Answered Mon 02nd of September, 2013 16:21:10 PM

Because each patient has two SI joints, coders can append modifier -50 (bilateral procedure) to the code for the SI joint injection. However, many payers do not like modifier -50, so coders would need to bill the injections on two separate line items in those cases.

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