# facility billing for SI joint with ultrasound



## pyoung4609 (Feb 16, 2016)

Can anyone tell me if we are to use G0260 if the SI joint injection is using ultrasound for outpatient facilities and ASC? I understand physicians use 20611 but I can not find anything about the hospitals and ASC's.


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## dwaldman (Feb 16, 2016)

If fluoroscopic guidance is not used then the trigger point code is to be reported under 20552 for SI joint injection with ultrasound. This is  found in  the AMA CPT Professional edition manual to report CPT 20552. So if the correct coding for SI Joint injection without fluoroscopic guidance is CPT 20552, then that same principle would apply to the facility charge. 

G0260 Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography  

The above code is reported when the SI joint injection is performed with fluoroscopic guidance and is reported by the physician as 27096. If the physician is reporting CPT 20552 the facility would also be reporting 20552.



http://www.hcpro.com/content.cfm?dp=HIM&content_id=283478&publication=859&

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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https://www.federalregister.gov/art...t-prospective-payment-and-ambulatory-surgical


Panel Recommendation: CMS should delete HCPCS code G0259 (Injection procedure for sacroiliac joint; arthrography) and HCPCS code G0260 (Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography), and instead use CPT code 27096 (Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography, when performed) with a status indicator of “T,” and assign CPT code 27096 to APC 0207 (Level III Nerve Injections).

Response: In the CY 2013 OPPS/ASC proposed rule, we did not accept the Panel's recommendation to delete HCPCS code G0259 and G0260 and instead use CPT code 27096 with a status indicator of “T” and assign CPT code 27096 to APC 0207. For CY 2012, we assigned CPT code 27096 to status indicator “B,” meaning that this code is not payable under the OPPS. In order to receive payment for procedures performed on the sacroiliac joint with or without arthrography or with image guidance under the OPPS, hospitals must use either HCPCS code G0259, which is assigned to status indicator “N” for CY 2012, or HCPCS code G0260, which is assigned to status indicator “T” for CY 2012, as appropriate. CMS created HCPCS codes G0259 and G0260 to separate and distinguish the image guidance procedure from the therapeutic injection procedure for the sacroiliac joint. As stated above, guidance procedures are packaged under the OPPS because we believe that they are typically ancillary and supportive to a primary diagnostic or therapeutic modality and are an integral part of the primary service they support.


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