Billing and Coding: Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ)

Coverage and medical necessity criteria for minimally invasive sacroiliac joint arthrodesis are defined by LCD L39810; billing must follow that LCD. Claims must include a valid ICD-10-CM diagnosis and, where applicable, the referring/ordering physician's name and NPI; procedure codes may be subject to NCCI and OPPS edits. Medical records including history, physical exam, and diagnostic test results must document medical necessity and be available to Medicare on request.

"Coverage for minimally invasive arthrodesis of the sacroiliac joint (SIJ) is determined by the Local Coverage Determination L39810; follow the clinical indications and medical necessity criteria in..."

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