Anesthesia Coding Alert

" Recent studies have estimated that 10 to 30 percent of those who suffer from chronic low back pain may have sacroiliac (SI) joint dysfunction. SI joint dysfunction often is related to a traumatic injury, such as falling and landing on the buttocks, or automobile accidents where the driver's leg is extended at the time of impact. Even simple twisting motions, such as shoveling snow or swinging a golf club, can result in SI joint sprain, which may eventually lead to SI joint dysfunction. Symptoms usually include pain felt on one side of the lower back or buttocks. This pain can radiate downward toward the knee and, in rare cases, extend to the ankle or foot. Yet, SI joint dysfunction is difficult to diagnose because it mimics the symptoms of other conditions, such as disc herniation and radiculopathy. Perhaps as frustrating as diagnosing SI joint dysfunction, obtaining appropriate reimbursement for diagnosis and treatment presents its own challenges. The key for coders lies in knowing which diagnoses and treatments are medically necessary and reimbursable by Medicare and other insurers. Diagnosing SI Joint Dysfunction SI joint dysfunction is a chronic pain condition, meaning the patient must have persistent pain for three months or more. The physician may perform a thorough physical examination and order a magnetic resonance imaging (MRI) or other diagnostic scan to rule out the possibility of another condition, such as a slipped disc. The pain management physician also might perform a diagnostic SI joint injection of lidocaine, occasionally including a steroid solution to reduce inflammation. If the patient feels relief after the injection, the physician can infer that the sacroiliac joint is the source of the pain.

Cynthia Thompson, CPC, a consultant with Gates, Moore and Company, a healthcare consulting firm in Atlanta, says, Report CPT 27096 (Injection procedure for sacroiliac joint" arthrography and/or anesthetic/steroid) for the injection procedure and 76005 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures ... including neurolytic agent destruction) for the fluoroscopic guidance. If injections are performed bilaterally append modifier -50 (Bilateral procedure) to 27096. Some carriers may prefer modifiers -LT (Left side) or -RT (Right side)."" Thompson also suggests that the pain management physician add modifier -26 (Professional component) to 76005 if the service is provided in a facility where the physician does not own the radiology equipment.

The local medical review policy (LMRP) for Empire Medicare Services New York state's Medicare carrier also states that the appropriate J code (i.e. J2000 for lidocaine) for the injected agent should be entered on the same claim for the same date of service. Sally J. Trew RN CPC of GSA Healthcare Group in Gibsonia Pa. [...]