Neurology & Pain Management Coding Alert

Question: Some of our payers deny 77003 when we bill it with SI joint injections during the same session. I realize the fluoroscopy isn't payable with facet joint injections anymore, but shouldn't we get paid for the SI joint injection?

Minnesota Subscriber

Answer: Your first step in determining whether you can bill the fluoroscopy and sacroiliac (SI) joint injection separately is to check the date of service.

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.