# Ultrasound guidance 76942 done with Trigger point injection 20550



## Diana2032 (Sep 26, 2017)

Can I bill for the ultrasound guidance for needle placement of a trigger point injection? Although there are no bundling issues between the codes, this type of procedure sounds odd to me because the majority of patients treated are not overweight and do not suffer from any medical condition that would warrant the separate use of the ultrasound guidance. Can someone please provide some type of guidance.

Thank you,

Vanessa


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## Orthocoderpgu (Sep 28, 2017)

*Ultrasound should be exception, not the rule*

I'm speaking as someone who codes hand surgeries and have had trigger finger injections myself. To date, my two hand surgeons have never required ultrasound for a trigger injection. It sounds like your physician is using ultrasound routinely. The codes may not hit an edit, but before I would bill it out I would want the physician to document the medical necessity for the ultrasound to guide the needle for the patient. 

In three years coding for two hand surgeons I have never had either one of them ever use ultrasound.


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## melissasilva1031@gmail.com (Mar 22, 2018)

*Sorry so late to the party*

I code for Rheumatology.  We bill out trigger point with U/S guidance (not for every patient).  It is used to make sure needle placement is correct because without it you are injecting in the "dark" and can grantee pain relief.


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## Orthocoderpgu (Mar 22, 2018)

*I understand the reasoning for the ultrasound*

I do understand the reason behind using ultrasound. I know it's needed for guidance. Most of the trigger points that I have seen could be performed without the ultrasound. However, I understand that especially with deeper muscles you could not perform the injection without it. Most muscles that are injected are superficial and usually do not require it. At least that is what I have seen in multiple clinics. I would definitely bill it any time its needed and I would abdicate that decision to the physicians.


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## shecodes (Mar 28, 2018)

Ultrasound _can_ be used for trigger points, but as previously mentioned, the medical necessity would need to be documented. In addition, permanent, separate images need to be retained for the ultrasound. Is that being done?

There does happen to be a CPT Assistant in place stating that u/s can be billed with 20552, but that it is only billed once no matter how many trigger points are injected.

Curious as to why you've chosen 20550 for trigger point injection versus 20552?


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