# SI joint injections



## SLA*72 (Sep 7, 2012)

I work in Family Practice billing department and several of my docs will inject the SI joint without flouroscopy with kenalog mainly. In the past, prior to 2012 CPT 20610 was used as their documentation stated a joint space injection. Then in the Coding edge came out the article to use 20552 for all SI w/o flouroscopy. What is happening is the LCDs for 20552 only cover some diagnosis and has me questioning whethere these are really joint injections and not trigger point. The documentation clearly states joint space....if it was trigger point wouldn't the documentation state in the point of maximal tenderness. I appreciate any help.
Thank you,
Stephanie


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## Donna T (Sep 7, 2012)

Found this on the AMA website and thought it might be helpful to you...

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.


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## SLA*72 (Sep 7, 2012)

I looked around in the CPT and the AMA website and found this: so I do believe this is the most recent information: 


Pelvis and Hip Joint Introduction or Removal
▲27096 Injection procedure for sacroiliac
joint, anesthetic/steroid, with
image guidance (fluoroscopy or
CT) including arthrography when
performed
►(27096 is to be used only with CT or fluoroscopic imaging confirmation of intra-articular needle
positioning) ◄
*►(If CT or fluoroscopy imaging is not performed, use 20552) ◄*


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## aaron.lucas (Sep 7, 2012)

Per CPT 2012, if a SI joint injection is done without any guidance, then 20552 should be used instead.  The reason for this is that based on studies that have been done on epidural injections and SI joint injections, there are certain sites that have been deemed impossible, or near impossible to target accurately without guidance (which is why 77003 is included in the facet, transforaminal epidural, and SI codes).  Therefore if guidance is not used, then the thinking is the doctor is not actually performing an SI injection (because you can't hit the joint without visualization), so it must be an injection of the surrounding tissue (i.e. muscles/trigger points).  It does seem odd to not use a joint code, but if that's what CPT says to use, then that's what we use, know what I mean?  Hope this helped explain it.


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## SLA*72 (Sep 7, 2012)

Thank you both for your responses. The documentation by the providers does say SI joint. If this is the case I wonder how they could do that without having the imaging but then again in our offices they do the joint injections, arthrocentesis on knee, elbow, wrist, shoulder, et.al. and in the major arthro injection code hip is inclusive but it also states in the CPT that the are eg. (examples) so this means it's not an all inclusive list and it could include the SI Joint being in the hip, pelvic area. The explanation you do state, Aaron, does make sense....the accuracy of getting right at the si joint without seeing it seems difficult. What puzzles me is the fact that the parenthetical referring to the 20552 code being used for those injections to si joint w/o flouroscopy or CT is not anywhere near the 20610 code sets nor the 20552 code sets in reverse parenthetical. It's confusing. I appreciate the input I am receiving. Thank you~


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