SIJ ligament

[bedrock]

1-CMS rules are now changing, so a bit of a moot point, but I"d like to ask how many of you do a periarticular or SIJ ligament injection some of the time as part of your treatment for the sacroiliac joints?

2-How many of you will consider periarticular or SIJ ligament injections if patient gets partial relief after a dedicated SIJ injection, and residual pain is located right at the SIJ and tender to palpation and provocative tests?


appreciate your thoughts

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[GlowInTheDark]

1-CMS rules are now changing, so a bit of a moot point, but I"d like to ask how many of you do a periarticular or SIJ ligament injection some of the time as part of your treatment for the sacroiliac joints?

2-How many of you will consider periarticular or SIJ ligament injections if patient gets partial relief after a dedicated SIJ injection, and residual pain is located right at the SIJ and tender to palpation and provocative tests?


appreciate your thoughts

One of my faculty always had us do 80% IA, 20% periligamentous so I just kinda stuck with that. Enter the joint, inject most in that area and on the way out do a little ligamentous.

 

[Agast]

Did it because I was trained that way and to be honest, never thought to question it

 

[bedrock]

thank you. I only thought to post about it because for an outside pain physician criticized me for doing a periarticular and ligament injection with my SIJ injections, and suggesting that I was money hungry.
I was shocked and so I wanted to hear how many on this forum do this as well.

It just makes sense and like Mr M used to say that he noticed some of his patients benefited more from the ligament/periarticular injection than they did from the SIJ injection.

 

[MitchLevi]

thank you. I only thought to question it because for an outside pain physician criticized me for doing a periarticular and ligament injection with my SIJ injections. I was shocked and so I wanted to hear how many on this forum do this as well.

It just makes sense and like Mr M used to say that he noticed some of his patients benefited more from the ligament/periarticular injection than they did from the SIJ injection.

I usually put about 0.5-1.0cc in the ligament.

 

[nvrsumr]

@bedrock Making so much $ off that tpi that is probably bundled most the time. U are likely doing more for the same $

To answer the original question I also redirected needle superior and did post ligament injections with si for about 10 years then stopped as wasn’t getting paid and never saw a difference

 

[bedrock]

@bedrock Making so much $ off that tpi that is probably bundled most the time. U are likely doing more for the same $

To answer the original question I also redirected needle superior and did post ligament injections with si for about 10 years then stopped as wasn’t getting paid and never saw a difference

Agree.

Though I did bill for a ligament injection + flouro guidance (77003+20550 with 59 modifier) in addition to the SIJ code, 27096.

Was generally paid by most insurance, but also felt that was an accurate description of the procedure I performed.

But my motivation was to help the patient. Do any of you feel that was egregious?

 

[BobBarker]

Can you describe this injection? I assumed you were just injecting as you pulled the needle out?

 

[Dr. Ice]

Do it all the time, have never billed for it. Also do it with sij PRP. Isn’t billing for it kinda like charging extra for ketchup packets at a fast food joint? Some places do it, never made sense to me

If you’re really doing it “for the patient” why bill? What are you gonna get an extra $10 for it? If you’re worried about documentation, just say you did it pro bono..I’m sure the insurance companies wont give a ****..

 

[GlowInTheDark]

Never even crossed my mind to bill as TPI. I’m injecting to treat SI, that’s what I’m doing.

We don’t bill people for TPI when doing MBB even though youre essentially dry needling the paraspinal.

 

[nvrsumr]

U should get paid for ur time. It’s fine to bill. We get nickel and dimed by the insurance companies hourly. I just don’t think it matters clinically

 

[Dr. Ice]

U should get paid for ur time. It’s fine to bill. We get nickel and dimed by the insurance companies hourly. I just don’t think it matters clinically

It also doesn’t matter financially

 

[Ducttape]

Agree.

Though I did bill for a ligament injection + flouro guidance (77003+20550 with 59 modifier) in addition to the SIJ code, 27096.

Was generally paid by most insurance, but also felt that was an accurate description of the procedure I performed.

But my motivation was to help the patient. Do any of you feel that was egregious?

that is a concern. pretty sure you cant bill for both. kind of like how you cant bill for an MBB and a TF at the same time.

i think it is not kosher with Medicare guidelines in multiple fronts - you are doing 2 different injections on the same patient at the same sitting (without exemptions for doing so). you are also injecting essentially the same site and "double dipping" on the billing.


not saying what you are doing is wrong from a clinical standpoint. personally, i often will do the same as i remove the needle but it is local anesthetic that is part and partial to the SIJ, and is not billed.

 

[Laryngospasm]

I think what’s egregious is what a plain image guided SIJ injection pays.. not you billing for a ligament injection.

 

[Welcome123]

thank you. I only thought to post about it because for an outside pain physician criticized me for doing a periarticular and ligament injection with my SIJ injections, and suggesting that I was money hungry.
I was shocked and so I wanted to hear how many on this forum do this as well.

It just makes sense and like Mr M used to say that he noticed some of his patients benefited more from the ligament/periarticular injection than they did from the SIJ injection.

He sounds like a narcissist (not unusual for doctors)
What he does is ok but if you step out to add a small procedure that may be of added benefit with minimal risk the only possible explanation is financials
I wouldn’t sweat it. Keep doing the ligament

 

[blokdoc]

I will inject on my way out from an epidural and charge it as a trigger point.

 

[Dr. Ice]

He sounds like a narcissist (not unusual for doctors)
What he does is ok but if you step out to add a small procedure that may be of added benefit with minimal risk the only possible explanation is financials
I wouldn’t sweat it. Keep doing the ligament

Those who think others are narcissists are most likely the narcissists

 

[MitchLevi]

Those who think others are narcissists are most likely the narcissists

What?

 

[Dr. Ice]

.

Be careful using the word narcissist. Millennials love to throw this word around. In reality those that categorize someone else as a narcissist are in fact the narcissists

 

[Welcome123]

Do it all the time, have never billed for it. Also do it with sij PRP. Isn’t billing for it kinda like charging extra for ketchup packets at a fast food joint? Some places do it, never made sense to me

If you’re really doing it “for the patient” why bill? What are you gonna get an extra $10 for it? If you’re worried about documentation, just say you did it pro bono..I’m sure the insurance companies wont give a ****..

The concern would be it may be considered an inducement.
There is a certain threshold dollar value (that is more than the $10 ) that you may get for the injection. It would not be calculated at an insurance reimbursement rate.
The $10 negotiated rate that you may get from the injection may easily be considered valued at $300-500.