Anesthesia Coding Alert

Home in on 4 areas to keep carriers from slashing justifiable payment

Sacroiliac (SI) joint injections are common fare for pain management practitioners, but some groups receive less reimbursement than expected because carriers downcode the claims. Before you fall victim to the same scenario, be sure your claims include all the necessary components for optimal reimbursement. Ensure an Appropriate Diagnosis Patients receiving SI joint injections can be searching for relief from a variety of conditions. Some of the most common ones include:

Arthritis (714.xx, Rheumatoid arthritis and other inflammatory polyarthropathies; 715.xx, Osteoarthritis and allied disorders; and 716.xx, Other and unspecified arthropathies)

Lupus (710.0, Systemic lupus erythematosus)

Sacroiliitis (720.0, Ankylosing spondylitis)

Inflammatory spondylopathies (720.89, Other inflammatory spondylopathies; other)

Other symptoms referable to back (724.8). Physicians usually try different combinations of medications or physical therapy to help treat these conditions. When these methods fail to provide pain relief, SI joint injections may be the next step. Coders such as Eileen Lorenco, RHIT, CS, CPC, a coder with Lahey Clinic in Burlington, Mass., say they have never seen LMRPs for SI joint injections. If you don't have an LMRP to work from, contact the carrier for information regarding their diagnosis policy. Confirmation Is the Key The SI joint is difficult to inject and requires precise needle placement plus confirmation of correct placement before the actual injection. "Without guidance, the physician can't be sure the pain medication has reached the correct spot," Lorenco says. "Another consideration is that patients who are obese or who have unusual anatomy or scar tissue might be impossible to inject without confirmation."

The physician has two options for guidance and confirmation: fluoroscopy and arthrography. One of these always accompanies an SI joint injection. Fluoroscopy  is often the rule and not the exception for some physicians, says Cindy Clark, anesthesia coding supervisor for Anesthesiology Consultants in Savannah, Ga.

Although arthrography isn't usually routine, it can be more appropriate in situations that stress diagnosis:   To determine the cause of SI joint pain or the extent of damage - The physician injects dye or contrast to outline the joint and visualize where the problems lie. If the arthrography confirms a finding, the physician administers the injection.
  To evaluate the patient's anatomy - If the patient has a history of past spinal surgeries or trauma, he might have scarring in that area. Using arthrography to visualize the damaged area allows the physician to work around them during the procedure. The physician might also use arthrography to evaluate the anatomy of a patient he has never treated.

The physician can also use fluoroscopy as a diagnostic tool, but Lorenco says it's more commonly used as a localization tool.

"The doctor might choose to [...]