Neurology & Pain Management Coding Alert

Question: What is the difference between a sacroiliac (SI) joint injection and an SI joint arthrogram? How do I know the difference when requesting authorization prior to the procedure being rendered?

South Carolina Subscriber

Answer: An arthrogram requires a formal radiological interpretation and report that the physician uses for further diagnosis and treatment of the patient. It also requires that hard copies of multiple views of the arthrogram be obtained. In contrast, the fluoroscopic guidance used with a diagnostic and/or therapeutic SI joint injection is used solely for confirming that the needle was accurately placed within the joint capsule; which is far more commonly performed.

The Instructions for Use of the CPT® Codebook directs providers that "Reports are the work product of the interpretation of test results. Certain procedures or services described in CPT® involve a technical component (e.g., tests) that produce "results" (e.g., data, images, slides)...Some CPT® descriptors specifically require interpretation and reporting to report that code."

Coders can sometimes be confused by the injection of contrast during an SI joint injection procedure. Some physicians comment more than others about what they see once the contrast is within or around the joint, but that doesn't automatically point to an arthrogram. Even with fluoroscopy and a detailed description, the intent of the procedure is the SI joint injection rather than primarily a diagnostic radiologic study. Additionally, the physician won't complete a separate, formal radiological interpretation.

Your coding will change, depending on whether the physician completes a joint injection or arthrogram.

For an SI joint injection, submit 27096 (Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid) with 77003 (Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures [epidural, subarachnoid, or sacroiliac joint], including neurolytic agent destruction).

For an SI joint arthrogram, report 27096 with 73542 (Radiological examination, sacroiliac joint arthrography, radiological supervision and interpretation).