# TMJ Injection-Any ideas



## ckkohler

Any ideas on the correct CPT code for a TMJ injection for pain relief?  Research on the AAPC forum page(s) - only found 1 solid lead and that was to use 20605 ... any thoughts????

Thank you!


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## dwaldman

"The temporomandibular joint is the joint of the jaw and is frequently referred to as TMJ. There are two TMJs, one on either side, working in unison. The name is derived from the two bones which form the joint: the upper temporal bone which is part of the cranium (skull), and the lower jaw bone called the mandible. The unique feature of the TMJs is the articular disc. The disc is composed of fibrocartilagenous tissue (like the firm and flexible elastic cartilage of the ear) which is positioned between the two bones that form the joint. The TMJs are one of the only synovial joints in the human body with an articular disc, another being the sternoclavicular joint. The disc divides each joint into two. The lower joint compartment formed by the mandible and the articular disc is involved in rotational movement—this is the initial movement of the jaw when the mouth opens. The upper joint compartment formed by the articular disk and the temporal bone is involved in translational movement—this is the secondary gliding motion of the jaw as it is opened widely. The part of the mandible which mates to the under-surface of the disc is the condyle and the part of the temporal bone which mates to the upper surface of the disk is the glenoid (or mandibular) fossa.

Pain or dysfunction of the temporomandibular joint is commonly referred to as "TMJ", when in fact, TMJ is really the name of the joint, and Temporomandibular joint disorder (or dysfunction) is abbreviated TMD. This term is used to refer to a group of problems involving the TMJs and the muscles, tendons, ligaments, blood vessels, and other tissues associated with them. Some practitioners might include the neck, the back and even the whole body in describing problems with the TMJs."

http://en.wikipedia.org/wiki/Temporomandibular_joint

20605 ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; INTERMEDIATE JOINT OR
BURSA (EG, TEMPOROMANDIBULAR, ACROMIOCLAVICULAR, WRIST, ELBOW
OR ANKLE, OLECRANON BURSA)

The EG of the in the descriptor for 20605 gives the example of temporormandibular joint as an intermediate joint, other codes not involving the joint such as tendon injection or trigger point injection are also found in the UHC medical policy below which they indicate if the plan excludes coverage for this type of treatment it will not be covered 

"When a plan excludes coverage for TMJ, all services for TMJ are not covered regardless of whether the underlying cause is due to medical or dental reasons or conditions. The TMJ exclusion applies to all provider types (ie: M.D., D.O., D.C., D.M.D., D.D.S., etc.)"

Below Aetna's policy has some interesting information regarding the condition:

http://www.aetna.com/cpb/medical/data/1_99/0028.html

Although the precise etiology of temporomandibular joint syndrome and temporomandibular joint disorder has not yet been identified, these conditions are believed to be the result of either "macro" or "micro" trauma affecting the joint and/or the associated facial musculature.  Macro-trauma is usually historically obvious (e.g., acute joint overload), and there is generally a documented history of direct trauma to the TMJ.  Micro-trauma is a chronic and insidious process, multi-factorial in presentation, and commonly associated with para-functional habits, stress and anxiety, sleep disorders, dysfunctional occlusion, and various myofascial conditions (e.g., fibromyalgia).

The etiology of temporomandibular disorders are intracapsular or extracapsular. Intracapsular abnormalities consist of internal derangements, including anterior disc displacement with or without reduction, disc perforation or fragmentation leading to degenerative joint disease, rheumatoid arthritis, synovitis, and neoplasia. Extracapsular abnormalities consist of myalgia or myospasm which may be related to trauma or parafunctional habits such as bruxism, tooth pain, or postural abnormalities.  

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## ollielooya

Did you see the article in the July 2011 of the "Coding Edge" that discusses coverage guidelines for TMJ?  This might help to narrow your search.  Based on that article possible coding scenarios MIGHT include  20605, 21240, 29800, 29804, 21010, 20552.  ---Suzanne E. Byrum CPC


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## ckkohler

Thank you for the guidance!  I appreciate it! (...and feel so silly!  I didn't even look in my CPT manual!)


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