Health Information Management

Tip: Correctly code SI joint injections

APCs Insider, August 17, 2012

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Historically, outpatient hospitals reported therapeutic sacroiliac joint (SI) joint injections using HCPCS Level II code G0260 (provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography). Hospital outpatient coders still report G0260 but do not code for the image guidance, which is not a change.

For physician coding, CPT code 27096 (injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance [fluoroscopy or CT]) remains the correct CPT code, but as of 2012, it now includes image guidance.
If the clinician does not document the use of image guidance, coders must go back to the trigger point injection codes. Clinicians say they don't know whether they are in the SI joint without that image guidance, so if they don't know they're in the joint, coders can't report a joint injection.
Because each patient has two SI joints, coders can append modifier -50 (bilateral procedure) to the code for the SI joint injection. However, many payers do not like modifier -50, so coders would need to bill the injections on two separate line items in those cases.

The tip is adapted from “Simplify diagnostic, procedural pain management coding” in the June Briefings on APCs.



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