Wiki 20610 SI injection

[dtricia]

Can this CPT be used for this anatonical site? I came across an LCD ( 31359) that says it is not appropriate to use this code for SI joint injection, rather use 27096. This code Injection procedure for sacroiliac joint, anesthetic steroid with image guidance (fluoroscopy or CT) including arthropgraphy when performed.
It ct or fluoroscopy is not performed use 20552.
Is this correct?
The note I am reviewing did not include any ct or fluoroscopy. In fact, whay started this whole review is that he billed the 20606 code with ultrasound- he did not use ultrasound and he used a code for a smaller joint.
I do not code these often, so I thought I had better ask .
Tricia D

 

[KMCFADYEN]

If the SI injection is done without any fluoroscopy or CT guidance you code it as 20552; if US guidance is used, you can add 76942, although many insurance companies will deny the US as not medically necessary.

Report 27096 Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed for SI joint injection of anesthetic/steroid with fluoroscopy or CT guidance. Do not report the guidance separately: It?s included in 27096.
Note that 27096 is a unilateral procedure. For bilateral injection, you may append modifier 50. For example, if a 38-year-old male undergoes bilateral SI joint injection with fluoroscopic guidance, report 27096-50.
Do not report 27096 for SI joint injection with ultrasonic guidance, or if done without radiological guidance. For these circumstances, CPT? directs us to report 20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s), along with 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation for the ultrasonic guidance (when provided). Do not report 20552 with modifier 50, even if bilateral injections are performed.