October 29, 2020
My physician performed an SI joint injection in the ASC under ultrasound guidance and wants to bill 27096 and 76942. Is this correct? The description of the codes say imaging is included.
No, this is not correct; you are correct to catch the inclusion of the imaging statement.
CPT code 27096 is defined as including fluoroscopic or CT guidance, but not ultrasound (Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed).
Per CPT guidelines, if ultrasound is used instead of fluoroscopy or CT, report a trigger point injection code 20552 (Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)) and 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation). CPT code 20552 is reported one time, whether the procedure is performed as a unilateral or bilateral procedure. Remember, CPT code 76942 has a professional and technical component; in the ASC setting you will append modifier 26 assuming the procedure note includes the required documentation for US guidance.
In answer to your question based on the ASC place of service, assuming documentation and medical necessity are present, the correct codes are:
If the procedure is performed in the office setting and you own the equipment, you may report 76942 without a modifier if the documentation supports the service.
Note: Some payor policies may deny payment of the US guidance ( CPT code 76942) with CPT code 20552.
*This response is based on the best information available as of 10/29/20.