How To Use CPT Code 27096

CPT 27096 refers to an injection procedure for the sacroiliac joint, involving anesthetic/steroid and image guidance. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT code 27096.

1. What is CPT 27096?

CPT 27096 is a medical procedure code that describes an injection procedure for the sacroiliac joint, which involves the use of anesthetic or steroid medication and image guidance, such as fluoroscopy or CT. This code is used by healthcare providers to bill for the specific service provided to patients who require pain relief or anti-inflammatory treatment in the sacroiliac joint area.

2. 27096 CPT code description

The official description of CPT code 27096 is: “Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed.”

3. Procedure

The 27096 procedure involves the following steps:

1. The patient is appropriately prepped and the area is anesthetized.
2. The provider inserts a needle into the sacroiliac joint, relying on fluoroscopic or CT guidance.
3. Once the position of the needle is confirmed, the provider injects the anesthetic or steroid medication for pain management.
4. The needle is then withdrawn.
5. If arthrography is performed, the provider injects contrast into the joint and takes multiple radiographic images.
6. A dressing is applied to the injection site.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 27096 services are those experiencing pain or inflammation in the sacroiliac joint area, which may be caused by conditions such as arthritis, trauma, or degenerative joint disease. The provider must determine that the patient requires an injection of anesthetic or steroid medication to manage their pain or inflammation, and that image guidance is necessary to accurately locate the injection site.

5. When to use CPT code 27096

It is appropriate to bill the 27096 CPT code when the provider performs an injection procedure for the sacroiliac joint using anesthetic or steroid medication, with image guidance (fluoroscopy or CT) and including arthrography when performed. This code should only be used when CT or fluoroscopic imaging is performed to confirm intra-articular needle positioning. If CT or fluoroscopy imaging is not performed, use CPT code 20552 instead.

6. Documentation requirements

To support a claim for CPT 27096, the following information needs to be documented:

• Patient’s medical history and physical examination findings
• Indication for the procedure, including the patient’s symptoms and diagnosis
• Description of the procedure, including the type of image guidance used and whether arthrography was performed
• Details of the medication injected, such as the type, dosage, and concentration
• Provider’s assessment of the patient’s response to the procedure
• Any complications or adverse events that occurred during or after the procedure

7. Billing guidelines

When billing for CPT code 27096, it is important to follow the appropriate guidelines and rules. This code is a unilateral procedure, meaning it applies to one side of the body. If the procedure is performed bilaterally, use modifier 50 to indicate this. Additionally, ensure that CT or fluoroscopic imaging is performed and documented, as this is a requirement for using CPT code 27096. If imaging is not performed, use CPT code 20552 instead.

8. Historical information

CPT 27096 was added to the Current Procedural Terminology system on January 1, 2000. The code was changed on January 1, 2012, with the previous descriptor being “Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid.”

9. Similar codes to CPT 27096

Five similar codes to CPT 27096 and how they differentiate are:

1. CPT 20552: This code is used for injections of single or multiple trigger points in one or two muscles, without the requirement of image guidance.
2. CPT 64450: This code describes an injection of anesthetic agent for peripheral nerve block, specifically for the nerves innervating the sacroiliac joint.
3. CPT 62322: This code is used for an injection of anesthetic or steroid medication into the epidural space of the spine, with image guidance.
4. CPT 64493: This code refers to an injection procedure for the paravertebral facet joint, using image guidance.
5. CPT 64495: This code is used for an injection procedure for the lumbar or sacral paravertebral facet joint, with image guidance.

10. Examples

Here are 10 detailed examples of CPT code 27096 procedures:

1. A patient with sacroiliitis undergoes a fluoroscopy-guided sacroiliac joint injection with anesthetic and steroid medication.
2. A patient with degenerative joint disease in the sacroiliac joint receives a CT-guided injection of anesthetic medication for pain relief.
3. A patient with post-traumatic sacroiliac joint pain undergoes a fluoroscopy-guided sacroiliac joint injection with steroid medication for inflammation reduction.
4. A patient with arthritis in the sacroiliac joint receives a CT-guided sacroiliac joint injection with anesthetic and steroid medication, including arthrography.
5. A patient with chronic sacroiliac joint pain undergoes a fluoroscopy-guided sacroiliac joint injection with anesthetic medication for pain management.
6. A patient with sacroiliac joint dysfunction receives a CT-guided sacroiliac joint injection with steroid medication for inflammation control.
7. A patient with sacroiliac joint instability undergoes a fluoroscopy-guided sacroiliac joint injection with anesthetic and steroid medication, including arthrography.
8. A patient with sacroiliac joint inflammation receives a CT-guided sacroiliac joint injection with anesthetic medication for pain relief and steroid medication for inflammation reduction.
9. A patient with sacroiliac joint degeneration undergoes a fluoroscopy-guided sacroiliac joint injection with steroid medication for inflammation control, including arthrography.
10. A patient with sacroiliac joint pain due to an autoimmune disorder receives a CT-guided sacroiliac joint injection with anesthetic and steroid medication for pain management and inflammation reduction.