Sacroiliac Joint Injection with Ultrasound Guidance

[taty313]

I am having a hard time getting pay by Medicare for SIJ injections performed at the office with ultrasound guidance. We are using 20552, 76942 with Dx: M53.3

Per CPT guidelines, if ultrasound is used instead of fluoroscopy or CT, report a trigger point injection code 20552 (Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)) and 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation). CPT code 20552 is reported one time, whether the procedure is performed as a unilateral or bilateral procedure. Remember, CPT code 76942 has a professional and technical component; in the ASC setting you will append modifier 26 assuming the procedure note includes the required documentation for US guidance.

What CPT code should be used?

 

[SharonCollachi]

My list of covered dx for Medicare for trigger points does not include M53.3

https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=52863&ver=35&MCDIndexType=3&mcdtypename=National+Benefit+Category+Analyses&SearchType=Advanced&CoverageSelection=Local&ArticleType=BC%7CSAD%7CRTC%7CReg&PolicyType=Both&s=All&CptHcpcsCodeFrom=20552&CptHcpcsCodeTo=20553&kq=true&bc=EAAAAAgAAAAA&

 

[vzayicek]

We have had success with 20552 and 76942 with M25.59 - pain specified joint. This is on our LCD in South Carolina.