CPT® 27096 Requires Fluoroscopic Guidance
Medicare data analysis indicates that a large percentage of claims submitted to Pinnacle Business Solutions (PBI) for sacroiliac (SI) joint injections with arthrography are reported using CPT® 27096 Injection procedure for sacroiliac joint, arthrography, and/or anesthetic/steroid without evidence of fluoroscopic guidance. Not only does this equate to a loss of as much as $78 per procedure, it sets up such claims for almost certain denial.
Simply by following CPT® and carrier guidelines, your practice can ensure proper claims payment for SI joint injections.
PBI instructs you on their website to report CPT® 27096 only if SI joint injections with arthrography are performed with fluoroscopic guidance. If fluoroscopy is not used, CPT® 20610 Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa) is more appropriate.
To report guidance, use CPT® 77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedure (epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve, or sacroiliac joint), including neurolytic agent destruction for needle localization of a basic therapeutic SI joint injection; or report CPT® 73542 Radiological examination, sacroiliac joint arthrography, radiological supervision and interpretation for a more diagnostic SI joint injection and arthrogram (CPT® Assistant, July 2008). If billing 73542, radiographic hard copies of the arthrograms need to be obtained in multiple views and a separate radiologic interpretation and report need to be dictated.
National non-facility Medicare payment rates for CPT® codes 77003 and 73542 are $59.15 and $78.63, respectively. Note that CPT® 73542 includes 77003, so it would not be appropriate to bill for both.
On a final note, if bilateral SI joint injections with arthrography are performed with fluoroscopic guidance, report 27096 with modifier 50 Bilateral procedure.