Image guidance is crucial to identify the optimal site for access to the joint. Therapeutic injections of the SI joint would not likely be performed unless other noninvasive treatments have failed. If the cause of pain in the lower back has been determined to be the SI joint, one of the options of treatment is injecting steroids and/or anesthetic agent(s) into the joint. Injection of local anesthetic or contrast material is a useful diagnostic test to determine if the SI joint is the pain source. Low back pain of SI joint origin is a difficult clinical diagnosis and often one of exclusion. The SI joints bear the weight of the trunk and as a result are subject to the development of strain and/or pain. The sacroiliac (SI) joint is formed by the articular surfaces of the sacrum and iliac bones.
If this has affected your payments, you may wish to submit adjustment claims after February 2 in order to correct the payment.Ĭoverage Indications, Limitations, and/or Medical Necessity Given this difference, claims that are submitted on or after the effective date for date of service, but prior to the implementation date, will be processed under the old rules. Please note that, for those Medicare carriers who did not make this change in a timely manner, there is a time lag between the effective date of Jand their new implementation date of February 2, 2004.
SACROCOCCYGEAL DISORDERS NOT ELSEWHERE CLASSIFIED CODE
Physicians who perform a sacroiliac joint injection of anesthetic agents or steroids (CPT code 27096) will now be reimbursed at the correct rate under the Medicare physician fee schedule. To rectify this problem, carriers have been instructed to add CPT code 27096 to their file of ASC approved procedures. SinceHCPCS code 27096 was not on the list of Medicare approved ASC procedures, physicians may have been overpaid when performing this procedure in an ASC. Physicians use CPCS code 27096 to bill for sacroiliac joint injection of anesthetic agents or steroids. Therefore, when a therapeutic sacroiliac joint injection is administered to a Medicare beneficiary at an Ambulatory Surgical Center, it should be reported by the ASC as HCPCS code G0260.HCPCS code G0260, however, is not payable under the Medicare Physician Fee Schedule (MPFS). HCPCS code G0260 (sacroiliac joint injection of anesthetic agents or steroids) was added to the list of approved ASC procedures for services performed on or after J(CMS-1885-FC, 3/28/03). Also, due to several inadvertent coding conflicts, physicians at ASCs who perform an injection procedure for a sacroiliac joint, arthrography, and/or anesthetic/steroid (Procedure code 27096) may be reimbursed incorrectly as well. Some Medicare carriers have been reimbursing incorrectly for sacroiliac joint injection of anesthetic agents or steroids (HCPCS code G0260) when the procedure is performed in an Ambulatory Surgical Center (ASC). Physicians and ambulatory surgical centers.
Payment to Ambulatory Surgical Centers (ASCs) for G0260 and to Physicians for 27096 when 27096 is Performed in an ASC Note: This article was updated on April 5, 2013, to reflect current Web addresses. G0260 – Injection procedure for sacroiliac joint provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography G0259 – Injection procedure for sacroiliac joint arthrograpy 27096 – Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed – average fee amount – $120 – $160
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