Orthopedic Coding Alert

Question: Our orthopedist performed an SI joint injection without arthrography or fluoroscopy. Should we use 27096 (Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid) with the modifier for reduced services (modifier -52)?

Pennsylvania Subscriber

Answer: No, 27096 is not appropriate even if you append modifier -52. A note in CPT states, "27096 is to be used only with imaging confirmation of intra-articular needle positioning." Therefore, because your orthopedist is not using imaging confirmation, you should not bill this code. The more appropriate code is 20610* (Arthrocente-sis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]). Although the sacroiliac joint is not listed as an example, it is considered a major joint.