Neurosurgery Coding Alert

Question: What codes can we submit for sacroiliac joint arthrography? Do the codes differ for outpatient and hospital settings?

New York Subscriber

Answer: When your physician administers a sacroiliac joint injection of an anesthetic and/or steroid with sacroiliac joint arthrography, you report code 27096 (Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance [fluoroscopy or CT] including arthrography when performed). This code includes imaging guidance, i.e. fluoroscopy and/or CT used by your physician to confirm the intra-articular needle positioning. However, if your physician administers a sacroiliac joint injection without imaging guidance, you do not submit code 27096. You instead report code 20552 (Injection[s]; single or multiple trigger point[s], 1 or 2 muscle[s]).

Note: You do not submit code 27096 to Medicare for outpatient billing.

Hospital billing: For sacroiliac joint arthrography on hospital Medicare patients, you report level II HCPCS code G0259 (Injection procedure for sacroiliac joint; arthrography). The code G0260 (Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography) is another alternative. This code is inclusive of arthrography, when performed. Physician practices can report G0259 but not G0260.

Also: Code 27096 is a unilateral procedure. For a bilateral procedure, use modifier 50 (Bilateral procedure).