Wiki SI joint injection

[janepolyakov]

Si joint injx w/o CT/fluoroscopy guidance should be billed as trigger points but Medicare doesn't consider SI pain a medically necessary dx for them... How do we bill this service?

 

[mitchellde]

well this one of those issues where this needed to be explained to the physician and then to the patient prior to the injection you would need an ABN so that the patient could be billed in the even Mcare denies. then you would bill the code with the AI modifier. But since the procedue has already been performed and you do not have an ABN signed by the patient then you will bill with the diagnosis the provider has documented and send the claim to Mcare, then if it is denied you cannot bill the patient and you are done.

 

[aaron.lucas]

Question about that Deb...is there any way to appeal a denial like that? Because if they bill the SI code it will get denied based on CPT guidelines, so is there way to perhaps appeal in a letter stating that due to CPT guidelines they had to bill the trigger point CODE, but the PROCEDURE performed matches the diagnosis? Has anyone been able to successfully work around the issue in this manner? Just a thought.

Thanks,

 

[mitchellde]

the only rationale I have heard regarding this is that if an SI injection is given into the SI joint there needs to be flouroscopy guidance, otherwise it is not truely an SI joint injection, that is why they say it has to be a triggerpoint. There is no clear logic for an appeal although I know it has been tried I just do not anyone that been successful. Yo have to appeal why you felt a triggerpoint injection is medically indicated, or why you felt you successfully did complete the SI injection without the aide of flouro.

 

[janepolyakov]

The physician uses imaging guidance by ultrasound instead for correct needle positioning. Still no dice?