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
Here’s a part of AMA’s Publication from CPT Assistant September 2003 (see how to bill cpt 20553)
ABOUT THE AUTHOR:
Ms. Pinky Maniri-Pescasio is the CEO and 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 Consultant.