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March Coding Q&A

Members & Publications

February 28, 2018

Got coding questions? Your Academy has the answers. Each month we feature a member’s question with an answer provided by AAPM&R’s Reimbursement and Policy Review Committee (RPRC).

Q: What is the appropriate code for billing an SI joint injection?

A: There are 2 possible codes that may be appropriate depending on the kind of imaging guidance you use.

Bill code 27096 for a sacroiliac joint injection when fluoroscopy or CT imaging is used to guide the injection.

Bill code 20552 for a sacroiliac joint injection when ultrasound is used. Since ultrasound is not included in code 20552, you will need to bill for it separately using code 76942 (ultrasonic guidance for needle placement). Additionally, members should check their payer’s policies prior to billing SI joint injection under ultrasound guidance, as it is may be considered a non-covered service. Payers may also provide guidance on billing for bilateral procedures. 

Find additional resources related to reimbursement here. Do you have a coding or billing question? Contact AAPM&R at codingquestions@aapmr.org for assistance. 

Accurate coding is the responsibility of the provider. This article is intended only as a resource to assist in the billing process.


Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.

 

 

 

 

 

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