Question: Answer: Effective Jan. 1, 2012, fluoroscopy is included with the SI joint injection, so you can't bill for both procedures during the same patient encounter. Instead, you'll only bill 27096 (Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance [fluoroscopy or CT] including arthrography when performed). Because the descriptor now states "with image guidance," you should not also report 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, or subarachnoid]). CPT includes the parenthetical note "Do not report 77003 in conjunction with 27096..." indicating that fluoroscopic guidance used in performance of a SI joint injection is not separately billable. In addition, it would not be compliant coding to append modifier 59 (Distinct procedural service) to 77003 to bypass the NCCI edits, if the fluoroscopy was only used with the SI joint injection.