# Bilateral Trigger point injections with SI injections



## LaVoncye (Aug 12, 2014)

Is it correct to code these two procedures together when performed during the same session on the same date? I have been billing them with 
20553 50
27096 51 
His note states bilateral trigger point injections and he specifies the muscles  with ultrasound
20553 50
76942
Then SI joint injection with Fluoroscopy
27096 51

I know the 51 is for distinct procedure outside of the primary procedure .  Correct me if I am wrong if the area of the trigger point injections are not in the same area of the SI joint injections it should be considered as two seperate procedures and the 51 is the correct modifier to use instead of the 59. ?

Also, the person who was coding the trigger point injections before used the 50 modifier but the 20553 is not listed as a bilateral code. Is the correct coding 
20553 for more than 3 muscles
76942 for the ultrasound
20796 51 for the SI joint with Fluro?


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## mitchellde (Aug 12, 2014)

You do not bill the 20553 with a 50 modifier, if the provider performed a bilateral trigger point injection then I assume two injection sites so it would be 20552.  Also the 51 does not communicate distinct procedure, it only communicates that both procedures were preformed in the same session. You need the 59 to indicated separate site. I am not certain the ultrasound is separately billable.


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## OCD_coder (Aug 12, 2014)

You are correct that the 20553 trigger point injections is not a bilateral procedure and should be billed by the total number of muscle injection.  But, the 20553 and 27096 bundle together.  So if they were performed on muscles in the same anatomical region or area of the SI joint the modifier 59 criteria would not be met.

More information is needed to determine if the 20553 code is billable.

A word of caution on ultrasound guidance from Medicare:
.....billing and coding the ultrasound guidance procedure code 76942 with an associated procedure must be clearly supported in the medical record as meeting the reasonable and necessary threshold for coverage for the given beneficiary or it should not be coded and submitted with the claim. On audit, if the documentation does not support that the ultrasound guidance provided clinical value, the claim will be denied.


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## dwaldman (Aug 13, 2014)

Code 76942 is a component of Column 1 code 27096 but a modifier is allowed in order to differentiate between the services provided. 

Code 20553 is a component of Column 1 code 27096 but a modifier is allowed in order to differentiate between the services provided. 

Code 20552 is a component of Column 1 code 27096 but a modifier is allowed in order to differentiate between the services provided. 


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I agree with the other responses you received. In order to bill 20553 there has to be 3 separate muscles documented as being injected. If it is found that less than 3 separate muscles were injected then the correct code selection is 20552

If it is determined that the trigger point injection was in the same anatomical area as the SI joint injection then the trigger point would be considered bundled. And it would be an time to review NCCI edits to consider for future blocks. Additionally, CPT 76942 is bundled with CPT 27096, if ultrasound was used to perform a procedure that is considered bundled with the primary procedure that utilized a different imaging modality. Then it would appear both the trigger point injection and the ultrasound would not be separately reportable.


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