# Injection Help Needed



## ediepierre (Dec 30, 2013)

Okay, I received a rejection because the number of units allowed was exceeded on the 96372,59 
How do I bill the following?
Office visit 99214
20552 - 4 separate injections - bi-lateral two shots in each leg (4 different muscles)
J1885 x 2
J1100 x 2

Please advise.

Thanks!!!!


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## OCD_coder (Dec 30, 2013)

More information is really needed to help you determine the ability to report 96372-59 with a 20553 (4 muscles), it would not be correct coding to use 20552-50 or x 2 units as these codes are base on the number of muscles and you cannot bill them bilaterally.  Second, identify what drug was given based on what administration type.

They are probably denying as they want to see the documentation and be sure the 96372 is really supported appropriately.


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## ediepierre (Dec 31, 2013)

This is what is on the superbill:

99214
20552 x 4 (two muscles on each leg)
96372 x 6
S0020 x 3
80176 x 1
J1885 x 1
J1100 x 1


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## mitchellde (Dec 31, 2013)

Truely we need to know what was actually documented.  You cannot bill the 20552 with units greater than 1.  If you have 4 muscles then you use the 20553 with 1 unit.  You cannot bill the S0020 as it is inclusive,  and you have not identified what the 6 injections of the 96372 are.  Also what dx codes are you linking each line item to.


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## armen (Dec 31, 2013)

TPI injections are not coded this way. You can't use units. 20552 is for 1 or 2 muscles; 20553 - 3+ muscles. So, in your case you would bill 20553 since you injected 4 different muscles.


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## ediepierre (Dec 31, 2013)

I'm sorry, I got some clarification on the location of the shots.  The 20552 was bilateral injections 2 on each side in the multi-fidus and iliocostalis in the back.


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## mitchellde (Dec 31, 2013)

It does not matter if the injections are bilateral, 20552 is for 1 or 2 muscles and 20553 is for 3 or more.  You can only bill one code or the other for the total number of muscles injected.  The real question now is what is the 6 units of 96372 for?


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## ediepierre (Jan 2, 2014)

There were four shots (trigger points in the muscles) and then two additional shots...one of toradol and one of decadron.


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## OCD_coder (Jan 2, 2014)

I know most of us would like to review the procedure note to be sure we are giving you the best and most accurate information.  If.....IF....the documentation supports a 4-muscle trigger point injection (20553) and separately 2 IM injections, 1 with decadron and 1 with Toradol it may be billed with only 2 units of 96372-59.  I am curious a to the drug used for the trigger point injections as dry-needling is not a billable service per the CPT Assistant (I would have to look it up if needed).

20553
96372 x 2 - 59
Toradol x 1
Decadron x 1


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## ediepierre (Jan 2, 2014)

it was a bilateral procedure with two on each side of the back (only two muscles affected) given with marcaine and lidocaine (not dry needling).   The toradol and decadron are two additional injections given for a total of 6 injections.


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## mitchellde (Jan 2, 2014)

I am still very much confused.  If you injected 2 muscles then you need only 1 unit of 20552.  You cannot bill for the lidocaine or the marcaine.  Was the toradol and decadron given IM and if so the for what.  You do not billthe 96372 for the trigger points, the 20552 is the administration charge for that.  Were there in fact 2 trigger points AND 2 additional injections administered IM?  What you are stating just is not adding up and it would be very beneficial to have you post the actual note.  You say that this is what was listed on the superbill, so my question is have you read the actual note prior to coding the claim?


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## OCD_coder (Jan 3, 2014)

Your posts are confusing to us as you originally state bilateral trigger injections into the leg, now you are stating bilateral muscle injections into the back, regardless, the location doesn't matter so much as how many muscles were given trigger point versus just an IM injection.  If you take the "bilateral" out of your thought process and just add up the total number of muscles you will successfully code this correctly.  Originally you told us that a total of 4 muscles are injected, so your CPT code should be 20553, not 20552-50 and definitely not x 4 units.  These codes are limited to 1 unit on a claim for a single DOS.  But if you only did trigger point injections into 2 muscles TOTAL use the 20552.  

Trigger point injections: 
20552 use for 1-2 muscles anywhere on the body, leg, back, shoulders, neck etc.
20553 use for 3 or more muscles (whether 4, 5, 6, 7 etc)
Note:  *NOT* to be billed bilaterally - mod-50 is incorrect/inappropriate

You would use the IM injection 96372 each time drugs were administered, either by drug or combination of drugs.  Most importantly, you cannot bill a 96372 for a 2055X drug administration at the same site, it must be at a different site to apply the modifier 59 to the 96372.  Based on my experience 96372 has an invisible unit limit of 3 per DOS and then records need to be sent with the claim to support more.  

It is best to always share the actual procedure note verbiage so that we can see the whole picture.

Per this post information, this is the correct coding without reviewing the procedure note:
_2 on each side in the multi-fidus and iliocostalis, IM injection of two additional drugs._
4 muscles total = 20553 (No modifier)
96372 x 2 - 59 (Toradol, Decadron)


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## MarcusM (Jan 3, 2014)

ODG Criteria for the use of Trigger point injections:
Trigger point injections (TPI) with a local anesthetic with or without steroid may be recommended for the treatment of chronic low back or neck pain with myofascial pain syndrome (MPS) when all of the following criteria are met:
(1) Documentation of circumscribed trigger points with evidence upon palpation of a twitch response as well as referred pain;
(2) Symptoms have persisted for more than three months;
(3) Medical management therapies such as ongoing stretching exercises, physical therapy, NSAIDs and muscle relaxants have failed to control pain;
(4) Radiculopathy is not an indication (however, if a patient has MPS plus radiculopathy a TPI may be given to treat the MPS);
(5) Not more than 3-4 injections per session;
(6) No repeat injections unless a greater than 50% pain relief with reduced medication use is obtained for six weeks after an injection and there is documented evidence of functional improvement;
(7) Frequency should not be at an interval less than two months;
(8) Trigger point injections with any substance (e.g., saline or glucose) other than local anesthetic with or without steroid are not recommended;
(9) There should be evidence of continued ongoing conservative treatment including home exercise and stretching. Use as a sole treatment is not recommended;
(10) If pain persists after 2 to 3 injections the treatment plan should be re-examined as this may indicate an incorrect diagnosis, a lack of success with this procedure, or a lack of incorporation of other more conservative treatment modalities for myofascial pain. It should be remembered that trigger point injections are considered an adjunct, not a primary treatment.


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## ediepierre (Jan 7, 2014)

I am not privy to the notes as they are in the patient's chart.  I asked the provider for the information.  Thank you everyone for all your help!!


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