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Coding tip: Watch for different codes for SI joint injections

Ambulatory Surgery Reimbursement Update, May 15, 2007

Sacroiliac joint injections, also known as "SI joint injections," are injections of steroids/anesthetic agent into the joint of the sacroiliac area for relief of chronic pain.

This is the only procedure for which the code billed by the ASC facility differs from the code billed by the physician to Medicare for the same procedure-thus, the facility and physician codes do not match, as usually is the case.

The facility would bill the G0260 code to Medicare and use the 27096 code to bill to all other payers (unless the payer specifically requests the G-code). The physician uses the 27096 code to bill all payers for the SI joint injection. Use this code as stated, provided you use fluoroscopy in the SI joint injection procedure.

If the SI joint injection procedure is performed without the use of fluoroscopic guidance, it would be inappropriate to report either the G-code or the 27096 code. You should instead report the SI joint injection with code 20610 for an injection into a major joint. Both the ASC and the physician would use the 20610 code in this case.

If the SI joint injection is performed with arthrography, use the G-code or the 27096 code with the 73542-TC code (provided the payer allows billing of radiology services, which Medicare does not reimburse).

If the SI joint injection is performed without formal arthrography but with fluoroscopic guidance only, code the procedure using the G-code or the 27096 code and code 77003-TC for the fluoroscopy (provided the payer allows billing of radiology services, which Medicare does not reimburse).

This tip is brought to you by Ellis Medical Consulting, Inc.

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