Wiki SI Joint Injections

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coding4fun

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when coding SI joint injections without guidance, the book instructs you to use 20552 & 20553. I am not understanding how the SI JOINT can be coded with a code which clearly states trigger point "muscle" . The SI is a joint and not a muscle. I have been told by employer that the correct coding is 20610. Could someone please help me understand which code is used for a patient who has received SI joint injections without guidance.

Thank you, in advance, for any help with this matter.
 
coding4fun said:
when coding SI joint injections without guidance, the book instructs you to use 20552 & 20553. I am not understanding how the SI JOINT can be coded with a code which clearly states trigger point "muscle" . The SI is a joint and not a muscle. I have been told by employer that the correct coding is 20610. Could someone please help me understand which code is used for a patient who has received SI joint injections without guidance.

Thank you, in advance, for any help with this matter.
Click to expand...

The basis of the statement to use 20552/20553 if performed without guidance, is that without guidance, you cannot confirm that you are in the joint space. AMA has a CPT Assistant article regarding this. There's also other threads here about this.
 
SI joint injections with ultrasound guidance

What if the injection guidance is by ultrasound and not fluoroscopy or CT? Would it still be 27096 or can 20611 be used? We have gotten multiple answers but no one seems to know for sure.
 
coding4fun said:
when coding SI joint injections without guidance, the book instructs you to use 20552 & 20553. I am not understanding how the SI JOINT can be coded with a code which clearly states trigger point "muscle" . The SI is a joint and not a muscle. I have been told by employer that the correct coding is 20610. Could someone please help me understand which code is used for a patient who has received SI joint injections without guidance.

Thank you, in advance, for any help with this matter.
Click to expand...

For medicare patients, we bill G0260, but any other insurance (besides medicaid, they don't allow) we bill 27096. It includes the guidance, but its not a requirement for you to be able to bill the code.

Code description (27096):
"The physician injects the sacroiliac joint, the articulation between the sacrum and the ilium in the pelvis. The physician draws contrast, an anesthetic, and/or steroid into a syringe. Through a posterior approach, a needle (syringe attached) is inserted into the sacroiliac joint. Arthrography, CT, or fluoroscopic guidance may be used to guide the needle placement. The physician pushes on the syringe to deliver its content into the joint. The needle is withdrawn."

Hope this helps :)
 
Actually, 27096 requires use of either fluoroscopic or CT guidance. The CPT code description specifies as such "with image guidance (fluoroscopy or CT) 27096 should not be reported if the injection is performed when either no guidance is used or ultrasound guidance is used. CPT directs providers to report with a trigger point injection code.

CPT Changes 2012: An Insider's View states "The first parenthetical note following code 27096 has been updated to indicate that code 27096 is to be used only with CT or fluoroscopy imaging confirmation of intra-articular needle positioning. An instructional note has been added to indicate that code 20552 should be reported if CT or fluoroscopy image guidance is not performed."

Due to the overlapping structure anatomically of SI joint, it would be unlikely to verify true intra-articular SI joint injection without use of some type of image guidance. Likely the needle would be placed on the posterior edge of the SI joint and not within the joint. There are many ligaments and muscles along the posterior SI joint, hence CPT's directive to use the trigger point injection code for SI joint injection without fluoroscopy or CT.
 
coding SI with ultrasound

I would code 20552 because when you go to 27096 in the OPTUM expert coding, it leads you there. When you go to 20552 it tells you to code an additional code for u/s- 76942 - this is how I would code it. Hope this helps
 
Is there currecnt 2017 clarification by medicare on 20610 vs. 20552

I can not find any current/updated 2017 documentation as to si injection in a rhc clinic without image guidence proper coding:

Everything i find says that if you do a si injection in a clinic without image guidence you don't code it with a 20610, you code it as a trigger point injection 20552 but all dated 2014 or before.
My provdier was doing it this way, but she had an auditor show her documentation that it this had changed and told her to code it as a 20610. But the auditor didn't leave her a copy of what she showed her, just marked it on the audit.

My provider wants documentation as which is the current and correct way to code/bill the si injection without guidence in a rhc clinic.

Thanks!
 
20610 vs 20552

kimbre1 said:
I can not find any current/updated 2017 documentation as to si injection in a rhc clinic without image guidence proper coding:

Everything i find says that if you do a si injection in a clinic without image guidence you don't code it with a 20610, you code it as a trigger point injection 20552 but all dated 2014 or before.
My provdier was doing it this way, but she had an auditor show her documentation that it this had changed and told her to code it as a 20610. But the auditor didn't leave her a copy of what she showed her, just marked it on the audit.

My provider wants documentation as which is the current and correct way to code/bill the si injection without guidence in a rhc clinic.

Thanks!
Click to expand...

Kimbre1, Were you ever provided with this documentation? Everything I can find looks like it leads back to 20552/20553 and I currently have this same scenario. (SI Joint(s) injected, no guidance used per the records.)
 
I just wanted to share an update....

I was looking into this issue with 20552 and 20610, came across this post. I found some information I thought I would share in case anyone is reading this in the future!

AAPC clarified this situation.
https://www.aapc.com/blog/26649-straight-up-coding-for-sacroiliac-joint-injections/

Our local WPS medicare also posted a response on this subject although it is not recent
 
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