# SI joint injection 27096 wo fluoro guidance



## Mary Baierl

How would you code an SI joint injection (27096) without fluoroscopic guidance? If my doctor does it in the office. I have heard some say to code the large joint injection 20610? Is this accurate? RVU of 27096 is 3 times more than 20610. 

Then what if the doctor does a facet joint injection (64475) without fluoroscopic guidance? Would you just code a joint injection? Is the spinal facet a large joint 20610 or medium joint 20605? 

Is there an even better way to code these scenarios????


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## RebeccaWoodward*

*Question*

If an injection is administered into the sacroiliac (SI) joint without fluoroscopic imaging guidance, would it be appropriate to report code 20610 or code 27096? 

*AMA Comment*

From a CPT coding perspective, if an injection is administered into the SI joint without fluoroscopic imaging guidance, *then it would be appropriate to report code 20610,* Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa), for the injection administered into the SI joint without fluoroscopic imaging guidance. Doing it blindly is injecting the L5-S1 facet joint. 

The first parenthetical under 27096 clearly makes this point, ie, 27096 is to be used only with imaging confirmation of intra-articular needle positioning. 

It would not be appropriate to report code 27096, Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid, as fluoroscopic guidance is crucial to identify the optimal site for access to the joint. Code 27096 should only be reported when imaging confirmation of intra-articular needle position has been performed


I once read that a facet joint is considered intermediate.  I'm still looking for this information


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## Mary Baierl

Rebecca, Thank you so much for this AMA comment. Where is it published so I have a reference point?


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## RebeccaWoodward*

CPT Assistant, April 2004 / Volume 14, Issue 04


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## Mary Baierl

Thank you very, very much!


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## hawk9er

If you look in your CPT book at code 27096 you will see that, in parentheses, under the code the direction is: (If CT or fluoroscopy imaging is not performed, use 20552). So, 27096 is with imaging and 20552 is without. If imaging is performed, then the provider knows that they have entered the joint space, if imaging is not used then the provider is uncertain that they have entered the joint space, therefore a joint injection cannot be coded and procedure 20552 - trigger point injection is the appropriate code, per our CPT book.


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