# Piriformis injection with a sacroiliac joint injection



## celcano (May 23, 2016)

Good afternoon/evening my friends,
My physician is a piriformis injection with a sacroiliac joint injection.  He billed a 27096n 20552, 76942 and J0702.  When I ran this through my billing coding software, it showed 20552 as being bundled into 27096, but a modifier could be used.  In my limited experience, I'm not sure if it is or is not appropriate to use a modifier in this case.  Below is the description of his procedure:

Procedure:
Right Sacroiliac Joint and Piriformis Steroid Injection Under Fluoroscopy

After discussing risks, benefits, and alternatives to the procedure, the patient expressed understanding and wished to proceed.  The patient was brought into the fluoroscopy suite and placed in the prone position.  Procedural pause was conducted to verify: correct patient identity, procedure to be performed and as applicable, correct side and site, correct patient position, and availability of implants, special equipment or special instruments.  

The inferior portion of the right sacroiliac joint was identified and marked under fluoroscopy. The skin was sterilely prepped and draped in the usually fashion using betadine times three.  The skin and subcutaneous tissues overlying the inferior portion of the right sacroiliac joint were anesthetized with 1% Lidocaine without epinephrine using a 25G 1.5 inch needle and a 25G 3.5 inch spinal needle for deeper tissues.  The 25 gauge 3.5 inch spinal needle was then inserted down to the ilium just lateral to the inferior recess of the right sacroiliac joint.  The needle was then “walked off” medially into the sacroiliac joint. After negative aspiration, 0.5 cc volume of contrast (Omnipaque) was injected into the right sacroiliac joint confirming intraarticular spread of contrast without any evidence of intravascular spread.   A single radiograph was obtained (see below).  A 2 cc volume solution consisting of 1 cc of Celestone (6 mg) and 1 cc of 0.5% Bupivicaine without epinephrine was injected slowly and incrementally into the joint.  The 25 gauge 3.5 inch spinal needle was then withdrawn to the ilium just lateral to the inferior recess of the right sacroiliac joint.  The needle was then “walked off” the ilium inferiorly and advanced 1.5 cm lateral, 1.5 cm inferior, and 1.5 cm anterior into the right piriformis.   After negative aspiration, 0.5 cc volume of contrast (Omnipaque) was injected into the piriformis confirming spread along the piriformis muscle without any evidence of intravascular spread.   A 2 cc volume solution consisting of 1 cc of Celestone (6 mg) and 1 cc of 0.5% Bupivicaine without epinephrine was injected slowly and incrementally into the piriformis.  Following the injection the needle was withdrawn slightly and flushed with 1% Lidocaine as it was withdrawn.

The patient tolerated the procedure well and there were no apparent complications.  After an appropriate amount of observation, the patient was dismissed from the clinic in good condition under their own power.

So, would it be appropriate to bill for the piriformis injection as well as the sacroiliac injection?

Thank you all for your assistance.


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## KMCFADYEN (May 24, 2016)

I would code as:
27096 RT
20552 59
J0702 x 4

I do not see US guidance (76942) documented so I would not bill.
the Fluoro is included in the SI injection so it is not billed separately


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## celcano (May 27, 2016)

Thank you, Kelly.  I appreciate your taking the time to look at this.


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## Ckonen512 (Jul 17, 2019)

How would you code this in the office without US or Fluoro?  There's not a clear code for this situation from what I see.  I'm under the understanding it would be 20552 with the J code.  But in the event they do an aspiration at the same time as an injection you would code the 20610 with the j code.  Is this correct?


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