Primary Care Coding Alert

Question: FP dictates, "Injection (L) sacroiliac joint, depo medrol 80mg, lidocane 4 ml, marcaine 1 ml" and diagnosis sacroiliitis. Notes indicate "SI joint area". When I asked the physician, he said it isn't really a muscle or directly in the joint. What procedure code should I use?

Codify Member

Answer: Your FP is not describing a trigger point injection or a sacroiliac (SI) joint injection, because he's not injecting the muscle or the joint. If he's injecting the tendon sheath or ligament, look at 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar "fascia"]).

For an injection into the tendon origin, use 20551 (... single tendon origin/insertion). The National Medicare Database lists 720.2 (Sacroiliitis, not elsewhere classified) as a code that is frequently linked to 20550 and 20551.

Warning: Be skeptical about reporting a true SI joint injection, which falls under (27096, Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid). You should use 27096 only if your physician documents imaging confirmation of intra-articular needle positioning. In the past, some physicians would inject the SI joint -blindly- in the office, but experts say that approach is nearly impossible to complete accurately. Administering SI joint injections without fluoroscopy is risky.

Don't forget to report the HCPCS Level II code for the steroid. Three HCPCS Level II codes describe different dosages of Depo-Medrol (generic name: methylprednisolone acetate):

• J1020 -- Injection, methylprednisolone acetate, 20 mg
• J1030 -- Injection, methylprednisolone acetate, 40 mg
• J1040 -- Injection, methylprednisolone acetate, 80 mg.

Typically, you would use J1040 for an 80 mg dose. Some contractors and payers, however, require the 20 unit code with units. In this case, you would report 80 mg of Depo medrol as J1020 x 4.

Do not separately code for the lidocaine and marcaine. These are anesthetics used to numb the injection site and are considered part of the surgical package.