# Multiple types of pain inj on same DOS



## dyoungberg (Mar 2, 2012)

It is my experience that Medicare will not pay for more than 1 type of pain injection on a particular date of service.  Does anyone know for sure if this is the case with all insurance carriers?  Or are there companies that will pay for 2 different types of injections on the same day?

Thanks in advance for any input.  Happy Friday!


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## nrichard (Mar 2, 2012)

*Additional information needed*

Are you referring to reporting combinations of 20600, 26005 and 20610? Or are you asking about pain management injections or TPI injections 22552, 22553? Or are you refering to something in the anesthesia section?


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## dyoungberg (Mar 2, 2012)

I was able to find my answer else where but thank you for responding.


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## dwaldman (Mar 3, 2012)

"Accordingly, providing a combination of epidural block, facet joint blocks, bilateral sacroiliac joint injections, lumbar sympathetic blocks or providing more than three levels of facet joint blocks to a patient on the same day is considered not reasonable or necessary. Such therapy can lead to an improper diagnosis or unnecessary treatment."

I think the reason they have the above note found in certain Medicare local coverage determination policies, is if the patient has  multiple types of injections it might be more difficult to determine which was effective in treating a particular conditions when multiple exists and there was attempt to treat mulitple conditions at one encounter. The examples they give above are in close anatomical location of each other typically.

Another thing to consider is NCCI edits that involve certain code pairs.


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