Need help with SI joint injection w/ultrasound guidance

nsteinhauser

Expert
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Two Harbors, MN
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Anesthesiologist injects kenalog under live ultrasound guidance into the left and right SI joints. Medicare patient - NGS is the contractor. LCD says nothing about ultrasound guidance - just flouroscopic and CT - and those are included in the 27096.
So - 20552 with 76942 or am I way off here? I'd appreciate any help.
 

hgolfos

Guru
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Montgomery, Alabama
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You're correct 20552 & 76942. Unfortunately, I don't believe Medicare will pay you for it. We haven't been paid on appeal for those.

We had to advise our providers that they should get an ABN signed. Medicare doesn't cover SI joints injections without fluoro or CT.

Good luck.

H. Golfos, CPC, CANPC
 

dwaldman

True Blue
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Overland Park, KS
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I looked at I believe the policy you are referring to for NGS And I was looking at the below statement. They state applicable radiological and/or fluoroscopic procedures. Below if this is the correct carrier you are referring to is how to send inquiry. I would write them and ask would ultrasound guidance be an approved form of image guidance per their policy since this portion is vague.



Written Correspondence and Inquiries

Download and input your inquiry directly onto the Medicare Correspondence Request Form. PDF Internal Once completed, print and send to the appropriate address as indicated on the form. Please mail all written inquiries to:

Freedom of Information Act Inquiries

National Government Services, Inc.
P.O. Box 6131
Indianapolis, IN 46206-6131

Fax: 317-841-4518


SI joint arthrography and/or therapeutic injection of an anesthetic/steroid should only be reported when imaging confirmation of intra-articular needle positioning with applicable radiological and/or fluoroscopic procedures have been performed.


http://www.ngsmedicare.com/ngs/port.../?clearcookie=&savecookie=&REGION=&LOB=Part B

http://www.ngsmedicare.com/ngs/port...HN1MTQwMgk1NDTxdDYLMfYPNjQwsjPULsh0VAQwMirs!/


SACROILIAC (SI) JOINT INJECTIONS

The sacroiliac (SI) joint is a diarthrodial, synovial joint which is formed by the articular surfaces of the sacrum and iliac bones. The SI joints bear the weight of the trunk and as a result are subject to the development of strain and/or pain.

Indications for Sacroiliac (SI) Joint Injections:

Sacroiliac (SI) joint injections would be considered medically reasonable and necessary for the diagnosis and/or treatment of chronic low back pain that is considered to be secondary to suspected sacroiliac joint dysfunction. Diagnostic and therapeutic injections of the SI joint would not likely be performed unless conservative therapy and noninvasive treatments (i.e., rest, physical therapy, NSAIDs, etc.) have failed.

Diagnostic blocks of a sacroiliac joint can be performed to determine whether it is the source of low back pain. Arthropathy (joint disease) is diagnosed through a double-comparative local anesthetic blockade of the joint by the intra-articular injection of a small volume of local anesthetics (2 to 3 ml) of different durations of actions. A positive response should demonstrate initial pain relief greater than or equal to (> /=) 80%-90% and the ability to perform previously painful maneuvers. Steroids may be injected in addition to the local anesthetic.

Therapeutic sacroiliac (SI) joint injections of an anesthetic and/or steroid to block the joint for immediate, and potentially long lasting, pain relief are considered medically reasonable and necessary if it is determined that the SI joint is the source of pain in the lower back. The local anesthetic used for the procedure should not be billed.

SI joint arthrography and/or therapeutic injection of an anesthetic/steroid should only be reported when imaging confirmation of intra-articular needle positioning with applicable radiological and/or fluoroscopic procedures have been performed.

Limitations for Sacroiliac (SI) Joint Injections:

If previous diagnostic or therapeutic SI injections of an anesthetic and/or steroid to block the joint for immediate, and potentially long lasting, pain relief have not effectively relieved the pain, further injections would not be considered medically necessary.
 
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