20610 and 20552

kjustin

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Just read an article titled, "Move over obsolete pain management Coding, Part 1: make room for the latest in CPT coding in the april 2012 coding edge and I do not agree with what they say about the 20610 and 20552. They say to use the 20552 if there is no imaging guidance done. My physicians do these two procedures all the time and have never used any imaging guidance for them. The second thing that bothers me is 20610 is joint aspiration/injections and the 20552 is a trigger point. They are not even the same thing, so to use one instead of the other is ridiculous. Wondering what other peoples thoughts are on this and if I am reading this wrong please let me know, as the other coders here are reading it the same way. PLEASE ADVISE!!!!!!!!!
 
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20610 vs 20552

I agree with what you're saying... I don't know why we need to change it, but our facility has changed it because of that. So we now do 20552 for SI joint injections instead of 20610 like we used to. I would really like someone's opinion/expertise on this also.
 

aaron.lucas

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No, you didn't read it wrong. Per CPT 2012, if a SI joint injection is done without any guidance, then 20552 should be used instead. It's actually in CPT in the parenthetical notes for 27096. The reason for this is that based on studies that have been done on epidural injections and SI joint injections, there are certain sites that have been deemed impossible, or near impossible to target accurately without guidance (which is why 77003 is included in the facet, transforaminal epidural, and SI codes). Therefore if guidance is not used, then the thinking is the doctor is not actually performing an SI injection (because you can't hit the joint without visualization), so it must be an injection of the surrounding tissue (i.e. muscles/trigger points). It does seem odd to not use a joint code, but if that's what CPT says to use, then that's what we use, know what I mean? Hope this helped explain it.
 
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