The sacroiliac joint or SI joint (SIJ) is the joint between the sacrum and the ilium bones of the pelvis, which are connected by strong ligaments. The SI joints bear the weight of the trunk and as a result are subject to the development of strain and/or pain. We have already learnt about coding epidural injection codes 62320,62321, 62322, 62323, 62324, 62325, 62326 and 62327.
Different specific codes are used for sacroiliac joint or SI joint (SIJ) for different payers. CPT code 27096, HCPCS code G0259 and G0260 are the procedure codes used for SI joint injection. Fluoroscopic guidance is also used in SI joint injection, but it is included with the main procedure code.
Since fluoroscopy is the key to precision diagnostic injections and accurate therapeutic injections, procedure code 27096 should be billed when imaging confirmation of intra-articular needle positioning has been performed, since this code includes both the injection and the image guidance procedure.
Code description of CPT code 27096 & HCPCS code G0259, G0260
27096 – Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed
G0259 – Injection procedure for sacroiliac joint; arthrograpy
G0260 – Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography
For outpatient facility reporting for Medicare beneficiaries, assign HCPCS Level II code G0260, Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography, instead of CPT code 27096 for the sacroiliac joint injection.
Note, the imagining for guidance with fluoroscopy or CT is built in the descriptor of the code and should not be billed separately. If no guidance is used, then it is requires to bill using CPT code 20552.
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Do and Don’t for CPT code 27096
Procedure code 27096 represents a unilateral procedure. If bilateral SI joint arthrography is
performed, 27096 should be reported with a –50 modifier
Code 27096 includes CT or fluoroscopic imaging guidance for needle placement, injection of anesthetic or steroid, and arthrography if performed. Hospital billing for Medicare utilizes HCPCS Level II code G0260 for this procedure. Code G0259 is used when SI joint injection is done only for arthrography.
Use code 27096 for sacroiliac joint injection of contrast, anesthetic, or steroid when CT or fluoroscopic imaging is used. Use code 20552 if done without CT or fluoroscopic imaging.
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ICD 10 codes supporting medical necessity for CPT code 27096, G0259, G0260
M08.1 Juvenile ankylosing spondylitis
M12.551-M12.559 Traumatic arthropathy, hip
M12.851-M12.859 Other specific arthropathies, not elsewhere classified, right hip
M13.851-M13.859 Other specific arthritis, hip
M16.0-M16.9 Osteoarthritis of hip
M25.551-M25.559 Pain in hip
M25.751-M25.759 Osteophyte, hip
M43.27 Fusion of spine, lumbosacral region
M43.28 Fusion of spine, sacral and sacrococcygeal region
M45.6-M45.8 Ankylosing spondylitis
M46.1 Sacroiliitis, not elsewhere classified
M47.26-M47.28 Other spondylosis with radiculopathy
M47.816-M47.818 Spondylosis without myelopathy or radiculopathy
M47.896-M47.898 Other spondylosis
M48.061 – M48.062 Spinal stenosis, lumbar region without neurogenic claudication – Spinal stenosis, lumbar region with
neurogenic claudication
M48.07 Spinal stenosis, lumbosacral region
M51.14-M51.17 Thoracic, thoracolumbar and lumbosacral intervertebral disc disorders with radiculopathy
M53.2X7 Spinal instabilities, lumbosacral region
M53.2X8 Spinal instabilities, sacral and sacrococcygeal region
M53.3 Sacrococcygeal disorders, not elsewhere classified
M53.86-M53.88 Other specified dorsopathies
M54.14-M54.17 Radiculopathy
M54.30 – M54.31 Sciatica
M54.40 – M54.42 Lumbago with sciatica
M54.5 Low back pain
M70.60 – M70.62 Trochanteric bursitis
M70.70 – M70.72 Other bursitis of hip
M76.00 – M76. 32 Enthesopathies, lower limb, excluding foot
M99.04 Segmental and somatic dysfunction of sacral region
M99.05 Segmental and somatic dysfunction of pelvic region
M99.23 Subluxation stenosis of neural canal of lumbar region
M99.33 Osseous stenosis of neural canal of lumbar region
M99.43 Connective tissue stenosis of neural canal of lumbar region
M99.53 Intervertebral disc stenosis of neural canal of lumbar region
M99.63 Osseous and subluxation stenosis of intervertebral foramina of lumbar region
M99.73 Connective tissue and disc stenosis of intervertebral foramina of lumbar region
Q76.2 Congenital spondylolisthesis
S33.6XXA-S33.6XXS Sprain of sacroiliac joint
S33.8XXA-S33.8XXS Sprain of other parts of lumbar spine and pelvis
S33.9XXA-S33.9XXS Sprain of unspecified parts of lumbar spine and pelvis