# Procedure coding please help



## LaVoncye (Sep 2, 2014)

I received a procedure note from my physician for a patient Medicare and when I go through the CCI edit it is giving me a error message : Standards of medical/surgical practice. I have no idea what this means. 

This is the procedure 
trigger point injection : right shoulder area, thoracic and lumbar spine-sternocieidomastoid, trapezius, lattisimus dorsii, paraspinal muscles under ultrasound guidance

Scar injection 

ultrasound guided right shoulder injection

dx code 715.91
dx code 729.1
dx code 709.2

Per my physician these are all seperate procedures, Im confused as how to code this.

Please help!!!!


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## dwaldman (Sep 3, 2014)

trigger point injection : right shoulder area, thoracic and lumbar spine-sternocieidomastoid, trapezius, lattisimus dorsii, paraspinal muscles under ultrasound guidance

The above would represent 3 or more trigger point injections this would be reported with CPT  20553. Due to the fact 20553 represents 3 or more trigger points injections. CPT 20553 would be reported only once to capture all the separate muscles injected

Scar injection . Need to find out from the physician if this was a scar neuroma injection or just scar tissue or just inclusive to the trigger point series.

For a scar neuroma injection as seen below in AMA CPT Assistant codes for the nerve that is effected can be reported such CPT 64450

Scar tissue injection per CPT Assistant is unlisted 64999


But when reviewing the NCCI edits, if the scar injection involves a neuroma and is in the same anatomical area as the trigger point injections there are bundling issues.

Code 64450(column 1) has a CCI conflict with code 20553(column 2). A modifier is allowed to override this relationship. 

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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