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February 10, 2022

Multi-Jurisdictional Contractor Advisory Committee (CAC)/Subject Matter Expert Meeting - March 10, 2022

Topic: Sacroiliac Joint (SIJ) Interventions and Procedures

Questions for Sacroiliac Joint (SIJ) Interventions

For all questions, answers must be based on clinical literature with consideration of quality of evidence to support your answer.

For the diagnosis of SIJ dysfunction:

What physical exam findings are consistent with SIJ dysfunction which may lead to intervention?
Do you routinely use imaging and if so which ones?
Do you rule out inflammatory/infectious processes? If so, how?
Should you evaluate for depression and treat prior to SIJ interventions?
With the obese patient what should be done prior to injection or radiofrequency treatment (RF)?
Do you agree noninvasive conservative therapy should at minimum of 4 weeks?
At least two classes of medications prior?
Physical therapy?
What is the role if any of injection and/or RF of the SI joints in the management of inflammatory arthritis forms such as axial ankylosing spondylitis, psoriatic and other spondyloarthropathies?
Do you feel there is sufficient evidence to support the following diagnosis (ICD10) for SIJ injections and/or RF (diagnosis codes for 27096, 64451 and G0260)?
M46.1 Sacroiliitis, not otherwise classified
M47.816 Spondylosis without myelopathy or radiculopathy, lumbar
M47.817 Spondylosis without myelopathy or radiculopathy, lumbosacral
M47.818 Spondylosis without myelopathy or radiculopathy, sacral and sacrococcygeal region

Do you agree there is insufficient evidence to support the following diagnosis (ICD10) for SIJ injections and/or RF (diagnosis codes for 27096, 64451 and G0260)?

M43.16 Spondylolisthesis, lumbar
M48.061-M48.062 Spinal Stenosis, lumbar
M54.16 Radiculopathy, lumbar region
M53.3 Sacrococcygeal disorders, not otherwise classified
M70.61 Trochanteric bursitis, right hip
M70.62 Trochanteric bursitis, left hip
M96.1 Postlaminectomy syndrome
S32.0595 to S32.059S Fracture of lumbar vertebra
M51.36 Other intervertebral disc degeneration, lumbar region

Do you think any are miscoded? Do you think any codes are missing from either group?
Do you believe the evidence supports single diagnostic injections vs dual?
What do you believe should be the minimum pain relief from a single therapeutic injection? 50% or 75%?
How long should improvement last to be considered successful 6wks, 3 months, 6 months?
What does your assessment of the clinical literature conclude on the role of RF in management of SIJ dysfunction?
Does the literature support cooled vs heated RF?
Is one superior?
Can all branches be reached?
How long should it last to be considered successful?
Is there literature to support a role for cryoanalgesia?
Should diagnostic injections be required before fusion? If so one or two?
What does the evidence say in terms of the number of SIJ injections that is reasonable within 6 months? 12 months?
Should there be a minimum time between injections?
How about the number of RFAs in 12 months and minimum time between treatments?
Does the literature support any indications that SIJ injections need to be performed under sedation/anesthesia? How about RF?
What should be the minimal level of education/training to perform SIJ injections and RF?
How common is it to need SIJ interventions bilaterally?
Is there evidence to support the administration of SIJ injections at the same time as injections in other locations? (such as epidural and SIJ injection in same session)