Wiki Sacroiliac joint injections with ultrasound guidance

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judiism

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We perform sacroiliac joint injections with ULTRASOUND guidance in our office. The code 27096 description is SI joint injection with fluoroscopy or CT guidance.

Per the ICD-10 manual, SI joint injections with ultrasound should be coded 20552 (Injection(s); single or multiple trigger point(s), 1 or 2 muscles(s)) with 76942 (ultrasound guidance).

This is more of a curiosity question... my research finds that using code 20611 (injection of major joint) is not appropriate; however, I am unable to find the rationale for this. It seems counterintuitive as we are injecting a joint and not a trigger point.

Does anyone know the rationale as to why we use a TPI code as opposed to a joint injection code?

Thank you for your help!
 
There is a "future LCD" which will become effective 3/19/23 (there were a several other future LCDs for different jurisdictions).
You can search on the Medicare Coverage Database:
CGS Future effective LCD for Sacroiliac Joint Injections and Procedures (emphasis added by me):

(There is other useful information in the policy)

B. Diagnostic Sacroiliac Joint Injections

Diagnostic SIJI is used to determine if the etiology of pain is from the sacroiliac joint complex.3

Diagnostic SIJI are considered reasonable and necessary for patients who meet ALL the following criteria:

    1. The patient must meet the above criteria for Covered Indications for SIJI, AND
    2. The SI joint injections must be performed under CT or fluoroscopy image guidance with contrast, except ultrasound guidance may be considered reasonable and necessary when there is a documented contrast allergy or pregnancy, since the accuracy with ultrasound guidance is inferior to fluoroscopic guidance,6 AND
    3. SI joint injection are not performed with other musculoskeletal injections in the lumbosacral spine, AND
    4. The documentation should show direct causal benefit from the SI joint injection and not from other musculoskeletal injections or treatments, AND
    5. The diagnostic SIJI provided a minimum of 75% relief of primary (index) pain with the diagnostic SIJI (a positive diagnostic response is defined as ≥75% sustained and constant pain relief for the duration of the local anesthetic and ≥75% sustained and constant pain relief for the duration of the anti-inflammatory steroid) was measured by the SAME pain scale* at baseline. The measurements of pain must be taken pre-injection on the day of the SIJ injection, post-intervention on the day of the injection, and the days following the injection to substantiate and corroborate the pain scores consistent with the pain relief for the duration of the local anesthetic and/or steroid used.
 
Hi, wondering if you got any more insight on this? Our providers also do SI joint injections with Ultrasound. Sounds like Medicare just doesn't want them doing this. I had been using the trigger point injection code but now there aren't even any dx codes allowed per the Medicare policy that would apply to an SI joint injection.
 
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