Anesthesia Coding Alert

Question: We had a patient who was given bilateral sacroiliac joint injections. Our pain management specialist usually doesn't perform bilateral procedures, so I'm not sure about the correct coding or billing. Where can I find a fee schedule in order to bill this at a reasonable fee?

Oregon Subscriber

Answer: The 2010 Medicare national allowable rate for a single unit of 27096 (Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid) is $167.79 in an office site of service and $68.56 for a facility site of service.

Medicare processes bilateral procedures at 150 percent of the allowable rate for a single procedure, which translates to $251.69 for an office site and $102.84 for a facility site.

When you factor in modifier 50 (Bilateral procedure), most providers just double their fee for a single injection reported twice, and understand there will be an additionalwrite-off for the bilateral procedure reduction.

Many payers follow the Medicare policy, but others have special coverage issues or medical necessity requirements for sacroiliac (SI) joint injections, so check your local payer's guidelines before submitting your claim.