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A radiologic examination of the sacroiliac (SI) joints involves the use of X-ray imaging to visualize the area where the left and right winged pelvic bones connect with the sacrum, forming the posterior aspect of the pelvic ring. This examination is crucial due to the complex anatomy and irregular surfaces of the SI joints, which can pose challenges for accurate imaging. The procedure typically begins with an anteroposterior (AP) view, where the patient is positioned supine with knees or hips flexed, if feasible. Following the AP view, left and right oblique views are obtained with the patient recumbent and rotated approximately 25-30 degrees from the AP position. These oblique views capture images of the side that is elevated, even though the patient is positioned for the opposite side to be down. Additionally, posteroanterior views may be taken with the patient in a prone position. The primary purpose of this radiologic examination is to assist in diagnosing various conditions, including spondyloarthropathies associated with rheumatic diseases, inflammatory lesions affecting the SI joint, sacroiliitis, ankylosing spondylitis, juvenile spondyloarthropathy, arthritis linked to inflammatory bowel disease, psoriatic arthritis, reactive arthritis, as well as potential fractures or dislocations. The X-ray imaging technique utilizes indirect ionizing radiation to produce images of internal structures, leveraging the varying densities and compositions of human tissue to create a two-dimensional representation of the anatomical features. It is important to note that if fewer than three views are obtained, the appropriate code to report is 72200, while 72202 should be used when three or more views are taken for a comprehensive examination.
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The radiologic examination of the sacroiliac joints is indicated for the following conditions:
The procedure for the radiologic examination of the sacroiliac joints involves several key steps to ensure comprehensive imaging of the area. First, the patient is positioned supine for the anteroposterior (AP) view, which is typically the initial view taken. In this position, the patient's knees or hips may be flexed to enhance the visibility of the sacroiliac joints. Following the AP view, the next steps involve obtaining left and right oblique views. For these views, the patient is rotated approximately 25-30 degrees from the AP position, allowing for the imaging of the side that is elevated while the opposite side is down. This positioning is crucial for capturing the necessary angles to visualize the joint structures effectively. Additionally, posteroanterior views may be performed with the patient in a prone position, further aiding in the assessment of the sacroiliac joints. The combination of these views—three or more in total—provides a comprehensive examination of the sacroiliac joints, facilitating accurate diagnosis and evaluation of any underlying conditions.
After the radiologic examination of the sacroiliac joints, the patient may be advised to resume normal activities unless otherwise directed by the healthcare provider. There are typically no specific post-procedure care requirements associated with this imaging study, as it is a non-invasive procedure. However, the healthcare provider may discuss the results of the X-rays with the patient during a follow-up appointment, where any necessary treatment plans or further evaluations can be established based on the findings. It is important for the patient to report any unusual symptoms or discomfort following the procedure to their healthcare provider for appropriate management.
| Short Descr | X-RAY EXAM SI JOINTS 3/> VWS | Medium Descr | RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS | Long Descr | Radiologic examination, sacroiliac joints; 3 or more views | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | STV-Packaged Codes | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 4 - Diagnostic Radiology | Berenson-Eggers TOS (BETOS) | I1B - Standard imaging - musculoskeletal | MUE | 1 | CCS Clinical Classification | 226 - Other diagnostic radiology and related techniques |
| 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | TC | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles | FY | X-ray taken using computed radiography technology/cassette-based imaging | GC | This service has been performed in part by a resident under the direction of a teaching physician | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | Q5 | Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | CR | Catastrophe/disaster related | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GA | Waiver of liability statement issued as required by payer policy, individual case | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | KX | Requirements specified in the medical policy have been met | MA | Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition | MH | Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | QJ | Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2013-01-01 | Changed | Short Descriptor changed. |
| 2009-01-01 | Changed | Code description changed |
| Pre-1990 | Added | Code added. |
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