cpt code and description
27096 - Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed - average fee amount - $120 - $160
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
SACROILIAC (SI) JOINT INJECTIONS
The sacroiliac (SI) joint is a diarthrodial, synovial joint which is formed by the articular surfaces of the sacrum and iliac bones. The SI joints bear the weight of the trunk and as a result are subject to the development of strain and/or pain.
The sacroiliac (SI) joint is formed by the articular surfaces of the sacrum and iliac bones. The SI joints bear the weight of the trunk and as a result are subject to the development of strain and/or pain. Low back pain of SI joint origin is a difficult clinical diagnosis and often one of exclusion. Injection of local anesthetic or contrast material is a useful diagnostic test to determine if the SI joint is the pain source. If the cause of pain in the lower back has been determined to be the SI joint, one of the options of treatment is injecting steroids and/or anesthetic agent(s) into the joint. Therapeutic injections of the SI joint would not likely be performed unless other noninvasive treatments have failed.
Image guidance is crucial to identify the optimal site for access to the joint. Fluoroscopy is often the imaging method of choice. Once the specific anatomy is identified, the needle tip is placed in the caudal aspect of the joint and contrast material is injected. Contrast fills the joint to delineate integrity (or lack thereof) of articular cartilage, as well as morphologic features of the joint space and capsule. Procedure code 27096 describes the injection of contrast for radiologic evaluation associated with SI joint arthrography and/or therapeutic injection of an anesthetic/steroid. 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.
The injection procedure of the SI joint will be considered medically reasonable and necessary when it is used for imaging confirmation of intra-articular needle positioning for arthrography with or without therapeutic injection. In addition, the injection procedure of the SI joint will be considered medically necessary when an injection is given for therapeutic indications, such as injection of an anesthetic and/or steroid, to block the joint for immediate and potentially lasting pain relief. When therapeutic injections of the SI joint are performed, it would be expected that the record reflects noninvasive treatments (i.e., rest, physical therapy, NSAID’s, etc.) have failed.
SACROILIAC (SI) JOINT INJECTIONS
The sacroiliac (SI) joint is a diarthrodial, synovial joint which is formed by the articular surfaces of the sacrum and iliac bones. The SI joints bear the weight of the trunk and as a result are subject to the development of strain and/or pain.
STOP – Impact to You
Some Medicare carriers have been reimbursing incorrectly for sacroiliac joint injection of anesthetic agents or steroids (HCPCS code G0260) when the procedure is performed in an Ambulatory Surgical Center (ASC). Also, due to several inadvertent coding conflicts, physicians at ASCs who perform an injection procedure for a sacroiliac joint, arthrography, and/or anesthetic/steroid (CPT code 27096) may be reimbursed incorrectly as well.
CAUTION – What You Need to Know
Some Medicare carriers may not have been paying the facility fee to ASCs when they billed Medicare for HCPCS code G0260—injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrogrophy. In addition, due to several inadvertent coding conflicts, physicians may not have been paid correctly for HCPCS code 27096—injection procedure for sacroiliac joint, arthrography, and/or anesthetic steroid—when administered in an ASC. Both of these issues apply to services rendered on or after July 1, 2003
Be aware that carriers reimburse a facility fee to the ASC for HCPCS code G0260 for services performed on or after July 1, 2003, and that physicians who perform HCPCS 27096 is an ASC should be reimbursed the non-facility payment amount.
Background
HCPCS code G0260 (sacroiliac joint injection of anesthetic agents or steroids) was added to the list of approved ASC procedures for services performed on or after July 1, 2003 (CMS-1885-FC, 3/28/03). Therefore, when a therapeutic sacroiliac joint injection is administered to a Medicare beneficiary at an Ambulatory Surgical Center, it should be reported by the ASC as HCPCS code G0260. HCPCS code G0260, however, is not payable under the Medicare Physician Fee Schedule (MPFS). Physicians use CPCS code 27096 to bill for sacroiliac joint injection of anesthetic agents or steroids. Since HCPCS code 27096 was not on the list of Medicare approved ASC procedures, physicians may have been overpaid when performing this procedure in an ASC.
To rectify this problem, carriers have been instructed to add CPT code 27096 to their file of ASC approved procedures. Physicians who perform a sacroiliac joint injection of anesthetic agents or steroids (CPT code 27096) will now be reimbursed at the correct rate under the Medicare physician fee schedule. Please note that, for those Medicare carriers who did not make this change in a timely manner, there is a time lag between the effective date of July 1, 2003 and their new implementation date of February 2, 2004. Given this difference, claims that are submitted on or after the effective date for date of service, but prior to the implementation date, will be processed under the old rules. If this has affected your payments, you may wish to submit adjustment claims after February 2 in order to correct the payment.
Sacroiliac (SI) Joint Injections (CPT codes 27096 and G0260)
* Medicare does not have a National Coverage Determination (NCD) for Sacroiliac (SI) Joint Injections.
* Local Coverage Determinations (LCDs) which address sacroiliac injections exist and compliance with these LCDs is required where applicable. For state-specific LCD, refer to the LCD Availability Grid (Attachment F).
* For states with no LCDs, see the Wisconsin Physicians Services Novitas LCD for Transforaminal Epidural, Paravertebral Facet and Sacroiliac Joint Injections (L34892) for coverage guidelines.
(IMPORTANT NOTE: After searching the Medicare Coverage Database, if no state LCD or Local Article is found, then use the above referenced policy.)
These are the only procedure where the CPT codes the ASC facility and the physician will bill may differ – codes are 27096 OR G0260.
27096 - Injection procedure for Sacroiliac Joint, Arthrography and/or Anesthetic/Steroid G0260 - Injection procedure for Sacroiliac Joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without Arthrography to be billed by ASC facilities ONLY.
* The ASC should use the G0260 code to bill SI Joint Injections to Medicare.
* The professional side (Physician claim) for SI Joint Injections should be billed to
Medicare with the 27096 code.
* The G0260 code is on the Medicare ASC list of covered procedures. The 27096 is NOT on the Medicare list of covered procedures. The physician and facility
CPT Codes are Copyrighted by the claim coding will not match in this instance, but this coding is the correct way to code the procedure.
* The 27096 code is for use when the ASC facility is billing SI Joint Injections to ayors other than Medicare, unless they want the G-code instead. The facility would NOT bill the 27096 code to Medicare.
* Radiology codes – for SI Joint Injections performed with Arthrography, the 73542-TC code should be billed. The Fluoroscopy code to use with SI Joint Injections when Arthrography is not performed is code 77003-TC. These codes are billable provided the payor allows the billing of radiology services – which Medicare does NOT reimburse.
* The G-code and 27096 codes are for use billing SI Joint Injections performed with radiologic guidance. If the SI Joint Injection is performed without the use of radiologic guidance, neither the G-code nor the 27096 should be billed. SI Joint
Injections performed without the use of radiologic guidance should be billed using the 20610 code for an Injection into a Major Joint (which reimbursed at a low rate by Medicare). The 20610 code would be used by both the physician and the ASC
facility.
* For a Radiofrequency Treatment of the SI Joint, use code 64640. The most common diagnosis codes for SI Joint Injection procedures are 724.6 for Disorders of the Sacrum and 720.2 for Sacroiliitis. If an injection is administered in the Sacroiliac Joint without the use of Fluoroscopic guidance, report only the procedure code for the SI Joint Injection.
A formal radiologic report must be dictated when using the 73542 code for the Arthrography. Do not report code 77003-TC with code 73542-TC. The injection of contrast material is inclusive. This is a unilateral procedure; when a bilateral procedure is performed, bill it in a Bilateral manner by appending the -RT/-LT or -50 Bilateral Modifiers. Report CPT code 73542-TC for the Arthrography performed with the –TC Modifier.
27096 - Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed - average fee amount - $120 - $160
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
SACROILIAC (SI) JOINT INJECTIONS
The sacroiliac (SI) joint is a diarthrodial, synovial joint which is formed by the articular surfaces of the sacrum and iliac bones. The SI joints bear the weight of the trunk and as a result are subject to the development of strain and/or pain.
The sacroiliac (SI) joint is formed by the articular surfaces of the sacrum and iliac bones. The SI joints bear the weight of the trunk and as a result are subject to the development of strain and/or pain. Low back pain of SI joint origin is a difficult clinical diagnosis and often one of exclusion. Injection of local anesthetic or contrast material is a useful diagnostic test to determine if the SI joint is the pain source. If the cause of pain in the lower back has been determined to be the SI joint, one of the options of treatment is injecting steroids and/or anesthetic agent(s) into the joint. Therapeutic injections of the SI joint would not likely be performed unless other noninvasive treatments have failed.
Image guidance is crucial to identify the optimal site for access to the joint. Fluoroscopy is often the imaging method of choice. Once the specific anatomy is identified, the needle tip is placed in the caudal aspect of the joint and contrast material is injected. Contrast fills the joint to delineate integrity (or lack thereof) of articular cartilage, as well as morphologic features of the joint space and capsule. Procedure code 27096 describes the injection of contrast for radiologic evaluation associated with SI joint arthrography and/or therapeutic injection of an anesthetic/steroid. 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.
The injection procedure of the SI joint will be considered medically reasonable and necessary when it is used for imaging confirmation of intra-articular needle positioning for arthrography with or without therapeutic injection. In addition, the injection procedure of the SI joint will be considered medically necessary when an injection is given for therapeutic indications, such as injection of an anesthetic and/or steroid, to block the joint for immediate and potentially lasting pain relief. When therapeutic injections of the SI joint are performed, it would be expected that the record reflects noninvasive treatments (i.e., rest, physical therapy, NSAID’s, etc.) have failed.
SACROILIAC (SI) JOINT INJECTIONS
The sacroiliac (SI) joint is a diarthrodial, synovial joint which is formed by the articular surfaces of the sacrum and iliac bones. The SI joints bear the weight of the trunk and as a result are subject to the development of strain and/or pain.
STOP – Impact to You
Some Medicare carriers have been reimbursing incorrectly for sacroiliac joint injection of anesthetic agents or steroids (HCPCS code G0260) when the procedure is performed in an Ambulatory Surgical Center (ASC). Also, due to several inadvertent coding conflicts, physicians at ASCs who perform an injection procedure for a sacroiliac joint, arthrography, and/or anesthetic/steroid (CPT code 27096) may be reimbursed incorrectly as well.
CAUTION – What You Need to Know
Some Medicare carriers may not have been paying the facility fee to ASCs when they billed Medicare for HCPCS code G0260—injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrogrophy. In addition, due to several inadvertent coding conflicts, physicians may not have been paid correctly for HCPCS code 27096—injection procedure for sacroiliac joint, arthrography, and/or anesthetic steroid—when administered in an ASC. Both of these issues apply to services rendered on or after July 1, 2003
Be aware that carriers reimburse a facility fee to the ASC for HCPCS code G0260 for services performed on or after July 1, 2003, and that physicians who perform HCPCS 27096 is an ASC should be reimbursed the non-facility payment amount.
Background
HCPCS code G0260 (sacroiliac joint injection of anesthetic agents or steroids) was added to the list of approved ASC procedures for services performed on or after July 1, 2003 (CMS-1885-FC, 3/28/03). Therefore, when a therapeutic sacroiliac joint injection is administered to a Medicare beneficiary at an Ambulatory Surgical Center, it should be reported by the ASC as HCPCS code G0260. HCPCS code G0260, however, is not payable under the Medicare Physician Fee Schedule (MPFS). Physicians use CPCS code 27096 to bill for sacroiliac joint injection of anesthetic agents or steroids. Since HCPCS code 27096 was not on the list of Medicare approved ASC procedures, physicians may have been overpaid when performing this procedure in an ASC.
To rectify this problem, carriers have been instructed to add CPT code 27096 to their file of ASC approved procedures. Physicians who perform a sacroiliac joint injection of anesthetic agents or steroids (CPT code 27096) will now be reimbursed at the correct rate under the Medicare physician fee schedule. Please note that, for those Medicare carriers who did not make this change in a timely manner, there is a time lag between the effective date of July 1, 2003 and their new implementation date of February 2, 2004. Given this difference, claims that are submitted on or after the effective date for date of service, but prior to the implementation date, will be processed under the old rules. If this has affected your payments, you may wish to submit adjustment claims after February 2 in order to correct the payment.
Sacroiliac (SI) Joint Injections (CPT codes 27096 and G0260)
* Medicare does not have a National Coverage Determination (NCD) for Sacroiliac (SI) Joint Injections.
* Local Coverage Determinations (LCDs) which address sacroiliac injections exist and compliance with these LCDs is required where applicable. For state-specific LCD, refer to the LCD Availability Grid (Attachment F).
* For states with no LCDs, see the Wisconsin Physicians Services Novitas LCD for Transforaminal Epidural, Paravertebral Facet and Sacroiliac Joint Injections (L34892) for coverage guidelines.
(IMPORTANT NOTE: After searching the Medicare Coverage Database, if no state LCD or Local Article is found, then use the above referenced policy.)
These are the only procedure where the CPT codes the ASC facility and the physician will bill may differ – codes are 27096 OR G0260.
27096 - Injection procedure for Sacroiliac Joint, Arthrography and/or Anesthetic/Steroid G0260 - Injection procedure for Sacroiliac Joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without Arthrography to be billed by ASC facilities ONLY.
* The ASC should use the G0260 code to bill SI Joint Injections to Medicare.
* The professional side (Physician claim) for SI Joint Injections should be billed to
Medicare with the 27096 code.
* The G0260 code is on the Medicare ASC list of covered procedures. The 27096 is NOT on the Medicare list of covered procedures. The physician and facility
CPT Codes are Copyrighted by the claim coding will not match in this instance, but this coding is the correct way to code the procedure.
* The 27096 code is for use when the ASC facility is billing SI Joint Injections to ayors other than Medicare, unless they want the G-code instead. The facility would NOT bill the 27096 code to Medicare.
* Radiology codes – for SI Joint Injections performed with Arthrography, the 73542-TC code should be billed. The Fluoroscopy code to use with SI Joint Injections when Arthrography is not performed is code 77003-TC. These codes are billable provided the payor allows the billing of radiology services – which Medicare does NOT reimburse.
* The G-code and 27096 codes are for use billing SI Joint Injections performed with radiologic guidance. If the SI Joint Injection is performed without the use of radiologic guidance, neither the G-code nor the 27096 should be billed. SI Joint
Injections performed without the use of radiologic guidance should be billed using the 20610 code for an Injection into a Major Joint (which reimbursed at a low rate by Medicare). The 20610 code would be used by both the physician and the ASC
facility.
* For a Radiofrequency Treatment of the SI Joint, use code 64640. The most common diagnosis codes for SI Joint Injection procedures are 724.6 for Disorders of the Sacrum and 720.2 for Sacroiliitis. If an injection is administered in the Sacroiliac Joint without the use of Fluoroscopic guidance, report only the procedure code for the SI Joint Injection.
A formal radiologic report must be dictated when using the 73542 code for the Arthrography. Do not report code 77003-TC with code 73542-TC. The injection of contrast material is inclusive. This is a unilateral procedure; when a bilateral procedure is performed, bill it in a Bilateral manner by appending the -RT/-LT or -50 Bilateral Modifiers. Report CPT code 73542-TC for the Arthrography performed with the –TC Modifier.