# Multiple procedures - Trigger point Injection



## LaVoncye (Jul 25, 2013)

How would I code a Bilateral LFB  L3-4, L4-5, L5-S1 under fluro with a Trigger point Injection on three seperate muscles done during the same session. 

The payer is Carefirst National Account, Im thinking I should code it as follows:
64493 50  Dx codes 721.3
64494-50
64495-50
no Fluro code as it is included in the description for the procedures
20553 59 and list the muscles in box 19 of the hcfa. 
 He also stated that there was moderate sedation, 99144. Am I able to bill the mod sedation code as well. 
He stated that the patient has Cervical Myofascial pain, this Dx would be attached to the trigger point injection.
64493 50
64494 50
64495 50
20553 59
99144 59, 26 im not sure if the 26 is needed?

This looks crazy, Please help me out this is all new to me.


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## mcnaryk (Jul 25, 2013)

LaVoncye said:


> How would I code a Bilateral LFB  L3-4, L4-5, L5-S1 under fluro with a Trigger point Injection on three seperate muscles done during the same session.
> 
> The payer is Carefirst National Account, Im thinking I should code it as follows:
> 64493 50  Dx codes 721.3
> ...



Your first three codes are correct for the LFB: 64493-50, 64494-50, and 64495-50. Most payers are going to consider the trigger point inclusive to the facet blocks, but you can try to bill it. I personally would use modifier 51 on my 20553 and NO modifers are needed for the moderate sedation 99144. I hope this helps!


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## dwaldman (Jul 26, 2013)

What muscles were encompassed for 20553, if they are muscles that are in same anatomical location of the facet joint injections, you should not report 20553. If they are clearly documented in separate anatomical region (away from the lumbar spine area) then per NCCI modifier is allowed and would only be paid with modifier 59.


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