Wiki multiple procedures

[LaVoncye]

My Dr. Performed a trigger point injection and a SI joint injection in the same session on a medicare patient. Is it okay to code the procedure as follows:
20552 dx code 729.1
27096 51 dx code 724.6 and 721.3
76942 26 it was done at a out patient surgical center.
His note stated using U/S guidance the spinal needle was taken to the trigger point in the gluteus maximus , then the needle was advanced slightly further into the inferior aspect of the SI joint. It also stated that the solution was injected into the joint itself and a final fluoroscopic image was obtained.

Thanks for you help

 

[dwaldman]

IF you were describing a trigger point injection into a muscle into the joint in the cervical region and then an SI joint injection under fluoroscopic guidance that could warrant the 59 modifier on 20552. But in as close anatomical location as you are describe I would not separately report 20552 and without the 59 modifier it will bundle.

Why would both fluoroscopic guidance and ultrasound guidance be required? The way you described the procedure it sounds like the SI Joint injection was under ultrasound guidance then a final fluoroscopic view was taken?

If the SI joint block was guided by ultrasound than this would be reported with 20552. Since 20552 encompasses 1 to 2 muscles this would include the other injection performed.

If the SI Joint block was performed with fluoroscopic guidance, NCCI bundles 76942. Modifier is allowed but in the circumstance you are describing, it does not appear to be a separate anatomical area. So I wouldn't believe it would support adding the 59 modifier.

 

[dwaldman]

I meant a muscle in the cervical region. I didn't mean to state "joint"