Overview of CPT Code 20926: Injection, facet joint or sacroiliac joint, diagnostic or therapeutic

Overview of CPT Code 20926: Injection, facet joint or sacroiliac joint, diagnostic or therapeutic

CPT Code 20926 refers to the injection of a facet joint or sacroiliac joint for diagnostic or therapeutic purposes. This procedure is commonly used to alleviate pain and improve function in patients suffering from joint-related issues.

When CPT Code 20926 is Used?

This code is applicable in various clinical scenarios, including:

• Chronic lower back pain suspected to originate from facet joint dysfunction.
• Sacroiliac joint pain that has not responded to conservative treatments.
• Diagnostic evaluation of pain sources in patients with unclear diagnoses.
• Therapeutic intervention for pain relief in patients with confirmed facet or sacroiliac joint issues.

Symptoms Indicating This Procedure

Patients may report the following symptoms that could indicate the need for this procedure:

• Localized pain in the lower back or buttocks.
• Pain that worsens with certain movements or positions.
• Radiating pain into the legs or hips.
• Stiffness or reduced range of motion in the lower back.

Causes and Risk Factors

Several factors can contribute to the need for a facet joint or sacroiliac joint injection:

• Degenerative joint disease or osteoarthritis.
• Injury or trauma to the lower back.
• Inflammatory conditions such as ankylosing spondylitis.
• Poor posture or body mechanics leading to joint stress.

Diagnostic Tests Before Procedure

Before proceeding with the injection, the following diagnostic tests may be performed:

• X-rays to assess joint alignment and degeneration.
• MRI or CT scans for detailed imaging of the joints.
• Physical examination to evaluate pain response and mobility.
• Diagnostic nerve blocks to confirm the source of pain.

Procedure Description

The injection procedure typically follows these steps:

• Patient is positioned comfortably, usually lying face down.
• Skin is cleaned and sterilized at the injection site.
• Local anesthetic may be administered to minimize discomfort.
• A thin needle is inserted into the targeted joint under imaging guidance.
• A mixture of anesthetic and/or steroid medication is injected.
• Needle is removed, and a bandage is applied to the site.

Preparation for the Procedure

Patients should follow these preparation steps before the injection:

• Discuss any medications with the healthcare provider, especially blood thinners.
• Avoid eating or drinking for a few hours prior if sedation is planned.
• Arrange for transportation home if sedation is used.
• Wear comfortable clothing that allows easy access to the injection site.

Recovery and Aftercare

Post-procedure recovery typically involves the following:

• Rest for the remainder of the day after the procedure.
• Apply ice to the injection site to reduce swelling.
• Avoid strenuous activities for at least 24 hours.
• Follow up with the healthcare provider to assess pain relief and function.

Possible Complications

While generally safe, there are potential risks associated with the procedure:

• Infection at the injection site.
• Bleeding or bruising.
• Nerve damage or increased pain.
• Allergic reaction to the injected medication.

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Post-Procedure Follow-Up

Follow-up care is essential for monitoring recovery:

• Schedule a follow-up appointment within a week to assess pain relief.
• Report any unusual symptoms or complications immediately.
• Discuss further treatment options if pain persists.

Alternative Treatments

Patients may consider these non-surgical options:

• Physical therapy to strengthen muscles and improve flexibility.
• Chiropractic adjustments for spinal alignment.
• Medications such as NSAIDs for pain relief.
• Acupuncture or massage therapy for symptom management.

Home Care Tips

To aid recovery, patients can follow these home care tips:

• Stay hydrated and maintain a balanced diet.
• Engage in gentle stretching exercises as advised.
• Use heat or cold therapy as needed for pain relief.
• Keep the injection site clean and dry.

Patient Education & Prevention

To prevent recurrence, consider these educational points:

• Maintain a healthy weight to reduce joint stress.
• Practice good posture and ergonomics in daily activities.
• Engage in regular low-impact exercise to strengthen back muscles.
• Avoid repetitive motions that strain the lower back.

Billing and Coding Information

CPT Code: 20926

Category: Surgical Procedures

Common Modifiers:

• 50 - Bilateral procedure
• RT - Right side
• LT - Left side

Average Cost and Insurance Coverage

The cost of the procedure can vary widely:

• Average cost ranges from $300 to $1,500 depending on location and facility.
• Most insurance plans cover the procedure if deemed medically necessary.
• Patients should verify coverage details with their insurance provider.

Related CPT Codes

• 20610 - 'Arthrocentesis, aspiration of joint'
• 20605 - 'Arthrocentesis, aspiration, and/or injection into a major joint or bursa'

References and Sources

• Facet Joint Injections
• Sacroiliac Joint Injections