Intr-articular Injection medications

[Julie Thorne]

I was curious if anyone has any ideas as to a reimbursable medication that is not a steroid to be used intra-articularly for shoulders, sacroiliac, and knees (other tha Hyaluronic Acid- we already are using this). We have been using Sarapin with fantastic results, but as with all non-pharmaceuticals, it has started appearing on the insurance company "black lists" and we are getting denials.

 

We are a physical medicine clinic and a DC/MD practice, so I would like to stay more on the natural side.  My compounding pharmacist has suggested ketorolac/lidocaine and diclofenac/lidocaine as injectable, but I am not sure how I feel about NSAIDs intra-articular?

 

Also, just out of curiosity, without fluoro guidance, is 20610 an appropriate code for SI injections?

 

Any feedback would be GREATLY appreciated!

 

Julie Thorne, FNP-BC

[Jonathan Fenton]

Diclofenac is the only NSAID that doesn't inhibit GAG synthesis, so is the best option. You can use it, put it in your note, but I wouldn't bill for it or you'll be red flagged.
Lidocaine is chondrotoxic at and above 0.5%, and bupivacaine is just plain highly chondrotoxic.
I add glucosamine HCl to all joint injections. Recent research is perfect for its use but is not reimbursable
How do you get hyaluronate covered for any joint other than the knee?
Code for fluoro SI joint is 27096, and it includes the fluoro
Medicare says for US SI inj have to use trigger point code  plus US guidance code?

Jonathan Fenton, D.O.

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