# Intraspinous Ligament Injection



## Melissa Harris CPC (Jul 15, 2015)

Hello,

Can someone please point me in the right directions.  We have a patient with post-herpetic chronic pain that the physician did an instrapinous ligament injection over scar at T11-12, T5-6 and T6-7.   Is this a 20550??  The patient has Medicare and the LCD's have nothing even close to post herpatic pain.  

Thank you 
Melissa Harris


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## dwaldman (Jul 16, 2015)

If this was a scar neuroma injection it could possibly fall under the guidance as seen below from AMA CPT Assistant, but if it is solely a ligament being injected then CPT 20550 potentially might have to reported  with the GZ modifier and write off the denial. It has a 40-56 dollar reimbursement so it could potentially be self pay procedure with a reviewed and pre-signed ABN if the procedure was needed to be repeated.



AMA CPT Assistant
November 2013 page 14
Frequently Asked Questions:Surgery: Nervous System

Question: Is code 11900, Injection, intralesional; up to and including 7 lesions, or the unlisted code 64999 the appropriate code to report for injections of neuromas? 

Answer: Neither code is appropriate to report for injections of neuromas. A "neuroma" is a thickening of scar tissue on the nerve and/or lining of the nerve; therefore, the appropriate nerve injection code should be reported based on the nerve injected. For example, code 64455, Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, Morton's neuroma), and code 64632, Destruction by neurolytic agent; plantar common digital nerve, would be reported for a neuroma injection involving the plantar nerves in the foot.


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