27096 Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed
BCBS of Kansas has updated its policy, limiting how they will pay for SI injections.
BCBS of KS POLICY reads:
A. Injection into the sacroiliac joint for diagnostic or therapeutic purposes may be considered medically necessary when all of the following conditions are met:
- Pain originates from the sacroiliac joint; and
- Duration of pain of at least 3 months; and
- Average pain level of ≥ 6 on a scale of 1 to 10; and
- Failure to respond to more conservative management including physical therapy and non-steroidal anti-inflammatory agents; and
- Lack of obvious evidence for disc related or facet joint pain
- The injections are performed under radiographic guidance
Repeat Injections:
- Repeat injections are to be no more frequent than every 2 months
- Repeat injections extending beyond 12 months may be reviewed for continued medical necessity
B. Sacroiliac injection is considered experimental / investigational for all other indications.
C. Arthrography of the sacroiliac joint is considered experimental / investigational.
D. Radiofrequency ablation of the sacroiliac joint is considered experimental / investigational.
E. Fusion / stabilization of the sacroiliac joint for the treatment of back pain presumed to originate from the SI joint is considered experimental / investigational, including but not limited to percutaneous and minimally invasive techniques.
ICD-9 Diagnoses
| 720.2 | Sacroiliitis, not elsewhere classified | 724.3 | Sciatica | |
| 724.00 | Spinal stenosis, unspecified region other than cervical | 724.4 | Thoracic or lumbosacral neuritis or radiculitis, unspecified | |
| 724.01 | Spinal stenosis of thoracic region | 724.5 | Unspecified backache | |
| 724.02 | Spinal stenosis of lumbar region, without neurogenic claudication | 724.6 | Disorders of sacrum | |
| 724.03 | Spinal stenosis of lumbar region, with neurogenic claudication | 724.70 | Unspecified disorder of coccyx | |
| 724.09 | Spinal stenosis, other region other than cervical | 724.71 | Hypermobility of coccyx | |
| 724.1 | Pain in thoracic spine | 724.79 | Other disorder of coccyx | |
| 724.2 | Lumbago | 724.8 | Other symptoms referable to back | |
| 724.9 | Other unspecified back disorders |
CMS has a broader list of covered diagnosis codes. Basically the only ones acceptable to both are in bold print.
abinsights Contact Information
abinsights readers are invited to submit comments, questions, tips, and suggestions for articles on any subject related to billing, collections, coding, reimbursement, and compliance. Send to: Anesthesia Billing, Inc., P O Box 388, Newton, KS 67114-0388. Phone 316-281-3700. Fax 316-282-4322.
Our purpose is to help you meet inevitable challenges. We hope to deliver practical knowledge and solutions drawn from top resources and business publications in every issue, knowledge you can use today.
Reasonable attempts have been made to be accurate. However, medical billing, collections, coding and compliance are part science, part art, and even experts sometimes differ. Neither Anesthesia Billing, Inc., the editors, publisher, contributors, or consultants warrant or guarantee the information contained will be applicable or appropriate in all situations. For information specific to your practice, consult a qualified professional.
The information included in this publication is provided, among other things, to alert you to legal developments and should not be considered legal advice. Specific questions about how this information affects your particular situation should be addressed to your attorney.
Editor: Philip Blann (pblann@anesthesiabilling.com).
No Comments