Trigger Point Injections Coding and Billing (How to Bill CPT 20553 and 20552). Is this unilateral procedures?Are you Properly Coding and Billing for your Services?
Coding for Trigger Point Injections (which include how to bill cpt 20553)“Trigger points are described as hyper irritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. Trigger point researchers believe that palpable nodules are small contraction knots and a common cause of pain.”keyword tags: how to bill cpt 20553, billing trigger point injection
What Causes Trigger Points? It could be due to or but not limited to:
Injuries (e.g. whiplash)
Daily activities (especially of that are work-related) of repetitive
movements (e.g. typing, data entry)
Lack of exercise, stress and poor posture
Lack of activity
Poor back support
Poor sleeping positionThe trigger point codes are very specific and here our two codes (see how to bill cpt 20553)20552 – Injection(s); single or multiple trigger point(s), one or two muscles
20553 – Single or multiple trigger points(s), three or more muscles (AMA Guidelines: If imaging guidance is performed, see 76942, 77002, 77021)
Global Days: 0
*** Imaging/Radiology Crosscodes:
76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device)
Trigger point injections must be billed one line regardless how many injections.
For instance, if your pain doc performed trigger points on 2 muscles, report 20552 x 1 unit… (not 2 units for 2 muscles!)
CPT 20553 is NOT an add-on code!
Modifier -59 should not be used with these codes.
NO Anatomical Modifier because this service is NOT billable as Unilateral/Bilateral
Modifier –25 can be appended for E/M office visit if done on the same day and such is separate and identifiable medically necessary. Above and Beyond.Documentation in the patient’s medical record should include proper evaluation leading to the diagnosis of the trigger points, specific identification of the affected muscle(s). It must also be properly documented the reason why injections are the chosen as a treatment option.
Is the Code for Trigger Points / Muscles Group Injections Billable for Bilateral?
“Is the Code for Trigger Points / Muscles Group Injections 20552 – 20553 Billable as Bilateral?”
Another interesting question on Trigger Points Injection codes 20552-20553!
The answer is NO, it is not billable as bilateral. Because you are billing on the number of muscles or trigger points. There is no left and right on this procedure. You bill and code on the number of muscles or trigger points. Be careful! you do not bill for number of injections too! Again, identify the number of muscle(s) or trigger point(s).
A needle placement guidance is rarely used for trigger points injection procedure, but if the medical record shows that the physician used needle placement guidance, look at 77002 for the needle placement guidance code.
Here’s a part of AMA’s Question and Answer Per CPT Assistant May 2003
Question: “My physician performed two trigger point injections in two different muscles. Would it be appropriate to report code 20552 twice for the two injections?”
AMA Comment: “Code 20552-20553 are reported one time per session, regardless of the number of injections or muscles injected. Therefore, it would not be appropriate to report code 20552, Injection(s); single or multiple trigger point(s), one or two muscle(s) twice for the two injections administered.”
**** CPT is owned by the American Medical Association (AMA)
**** For more references: Consult your CPT code books. The National Correct Coding Initiative (NCCI) and third pary payer payment policies and guidelines
**** CPT Assistant September 2003
**** Always refer to your local carrier’s LCDs
keyword tags: how to bill cpt 20553, billing trigger point injection
Related Interventional Pain Management Modifiers:
22 Increased Procedural Services
50 Bilateral Procedure
51 Multiple Procedures
52 Reduced Services
58 Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
59 Distinct Procedural Service
63 Procedure Performed on Infants less than 4 kg
76 Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
77 Repeat Procedure by Another Physician or Other Qualified Health Care Professional
78 Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
79 Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
99 Multiple Modifiers
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
AR Physician provider services in a physician scarcity area
CR Catastrophe/disaster related
CS Item or service related, in whole or in part, to an illness, injury, or condition that was caused by or exacerbated by the effects, direct or indirect, of the 2010 oil spill in the gulf of mexico, including but not limited to subsequent clean-up activities
ET Emergency services
F1 Left hand, second digit
F2 Left hand, third digit
F3 Left hand, fourth digit
F4 Left hand, fifth digit
F5 Right hand, thumb
F6 Right hand, second digit
F7 Right hand, third digit
F8 Right hand, fourth digit
F9 Right hand, fifth digit
FA Left hand, thumb
GA Waiver of liability statement issued as required by payer policy, individual case
GC This service has been performed in part by a resident under the direction of a teaching physician
GJ "opt out" physician or practitioner emergency or urgent service
GR This service was performed in whole or in part by a resident in a department of veterans affairs medical center or clinic, supervised in accordance with va policy
KX Requirements specified in the medical policy have been met
LT Left side (used to identify procedures performed on the left side of the body)
PD Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days
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
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
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)
RT Right side (used to identify procedures performed on the right side of the body)
T1 Left foot, second digit
T2 Left foot, third digit
T3 Left foot, fourth digit
T4 Left foot, fifth digit
T5 Right foot, great toe
T6 Right foot, second digit
T7 Right foot, third digit
T8 Right foot, fourth digit
T9 Right foot, fifth digit
TA Left foot, great toe
XE Separate encounter
XP Separate practitioner
XS Separate structure
XU Unusual non-overlapping service
Trigger Point Coding Tip
Trigger point codes are grouped to reflect the total number of muscles treated, not how many injections the provider performs. When the provider treats one or two muscles with injections, regardless of the number of injections, report 20552, Injections, single or multiple trigger points, one or two muscles. When the provider performs trigger points on three or more muscles, report 20553, Injections, single or multiple trigger points, three or more muscles.
Coding examples include:
A patient with a history of back problems reports to the emergency department complaining of sharp lower back pain and aching legs. The provider discovers three trigger points in the patient's longissimus muscle, which is one of the deep muscles in the back, and performs therapeutic injections at each trigger point. Do not report 20553, Injections, single or multiple trigger points, three or more muscles, because the provider treated only one muscle. For this encounter, report 20552, Injections, single or multiple trigger points, one or two muscles.
Do you know that you can bill for a Smoking Cessation Face-to-face encounter? But the question that you may have is how do you bill for Smoking Cessation Counseling?
Here are your codes:
99406 Intermediate Smoking and tobacco use cessation counseling visit is greater than three minutes, but not more than 10 minutes
99407 Intensive Smoking and tobacco use cessation counseling visit is greater than 10 minutes
Diagnosis that Meets Medical Necessity (always refer to your payer's guidelines too!)
F17.200 Nicotine dependence, unspecified, uncomplicated
F17.201 Nicotine dependence, unspecified, in remission
F17.210 Nicotine dependence, cigarettes, uncomplicated
F17.211 Nicotine dependence, cigarettes, in remission
F17.220 Nicotine dependence, chewing tobacco, uncomplicated
F17.221 Nicotine dependence, chewing tobacco, in remission
F17.290 Nicotine dependence, other tobacco product, uncomplicated
F17.291 Nicotine dependence, other tobacco product, in remission
Z87.891 Personal history of nicotine dependence
How do you bill Smoking Cessation code with the EM or Evaluation and Management codes?
Append your Modifier 25 to the E/M Code and not on the Smoking Counselling Code!
Make sure you know the guideline of Modifier 25 and always know how to identify necessity.
Modifier -25, Significant, separately identifiable evaluation and management
service by the same physician on the same day of the procedure or other
This modifier must be appended with an E/M service. This is the modifier you will need to use
with the evaluation and management service done on the same day with other procedure done
by the same physician. It has to be above and beyond the usual preoperative and postoperative
encounter with the procedure. In fact, by using this modifier, it doesn't have to have a different
diagnosis reported. The most important thing is that, the E/M level should meet its key
components or if it is selected based on time with the patient (counseling and coordination). You
have to be careful in using this modifier. It must meet medical necessity. As you know, there are
procedures that already includes all other care and management.
Let's describe this modifier 25:
A patient came in for her monthly follow up for her chronic back pain. At the same time, patient
was complaining with severe headache. The pain doctor performed bilateral occipital block on
the patient at the time of service. You will append modifier 25 for the E/M code to indicate that both
services were rendered on the same day.
You don't use modifier 25 with E/M encounter that resulted to Decision for Surgery (we have
another modifier for this!)
ABOUT THE AUTHOR:
Ms. Pinky Maniri-Pescasio is the Founder of GoHealthcare Consulting. She is a National Speaker on Practice Reimbursement and a Physician Advocate. She has served the Medical Practice Industry for more than 25 years as a Professional Medical Practice Consultant.