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Ultrasound guided SI joint injections

hgolfos

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Montgomery, Alabama
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Does anyone have a physician doing these? There is no code for them in CPT and the notes for the SI joint code (27096) do not mention US guidance at all. There is also no Cat. III code that I am aware of. We are thinking of writing to CPT to get a formal stance on the issue. Currently the only compliant code is 20552 which seems inadequate to describe the service. Moreover, the SI joint dx codes don't support medical necessity for the TP code.

Any official documentation or guidance would be tremendously appreciated!!!
 

dwaldman

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http://www.ama-assn.org/ama/pub/phy...coding-billing-insurance/cpt/cpt-network.page

You could submit the question to confirm 20552 76942. Although it seems evident they are going to agree with this type of reporting, I would move forward with submitting the question if you need it in writing and benefit from getting the response from the AMA.


I noticed this Cigna medical policy stating they don't cover SI joint blocks with ultraound guidance. WPS Medicare J5 will only pay for use of SI joint blocks with fluoroscopy and don't cover ablation procedures of the nerves that innervate this joint. I am not sure if other carriers also policies regarding SI joint blocks performed with ultrasound guidance.

http://www.cigna.com/customer_care/...criteria_invasive_treatment_for_back_pain.pdf

Sacroiliac (SI) Joint Injection
CIGNA covers SI joint injection (CPT code 27096, HCPCS code G0260)) for the treatment of back pain associated with localized SI joint pathology (e.g., inflammatory arthritis) confirmed on imaging studies.
CIGNA does not cover EITHER of the following because each is considered experimental, investigational, or unproven:
• SI joint injection (CPT code 27096) for the diagnosis or treatment of acute, subacute, or chronic back pain or radicular syndromes
• ultrasound guidance (76942) for SI joint injection for any indication
 

hgolfos

Guru
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Location
Montgomery, Alabama
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Thanks for the info. Our provider is in Georgia and the majority of his patients are Medicare, (cahaba) Their SI joint LCD doesn't list 20552 at all and makes no mention of US guidance, only Fluoro and CT.
 
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