# 20551 and 20553



## themaid174@gmail.com (Aug 13, 2014)

Can someone help me with this?  Dr wants to bill 20551 and 20553.

Patient was placed in sitting position with palm facing upward. Wrist flexion against resistance was utilized to identify the most predominant pain site through the anteromedial forearm as well as the insertional regions of the bicep tendons. Four trigger point sites are identified in this region and injected with a total of 3mL of 0.25% bupivacaine and 30mg of Kenalog and an additional 1mL of 0.25% bupivacaine and 20 mg of Kenalog was injected through the biceps tendinous regions.

I don't see my Drs so every communication that I have with them are through fax.  How should I address this? Thanks in advance


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## mitchellde (Aug 13, 2014)

I think he is saying he injected four muscle areas and one tendon injection but it truely is not clear.  IF this is what was performed then were these four different muscle sites or four different muscles?  That will be the difference in the 20552 and the 20553.  However the dx code will be the sticking point as the 20552(3) and the 20551 will probably bundle together (check your CCI edits), and your dx is going to pain (I am assuming) and I am not certain this note will be strong enough to support an appeal.


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## dwaldman (Aug 13, 2014)

Code 20553 is mutually exclusive to code 20551 but a modifier is allowed in order to differentiate between the services provided. 

Per the CMS NCCI coding edits the two codes have bundling issue. 

The documentation needs to support that CPT 20551 was performed at tendon origin/insertion. This exact site has to be described to support that it was a separate site as the trigger point injection.

CPT 20552 is for 1-2 muscles injected. CPT 20553 is for 3 or more separate muscles injected. The documentation will describe the three separate muscles to support billing 20553. 

I would state something as described above and then state: 

In order to bill both suggested CPT codes. We need the following addendum to address:

The names of the 3 or more separate muscles to support CPT 20553.

We need the description of the exact location describing tendon insertion site or tendon origin site. This site will be required to be separate from the other muscles described by the trigger point injection to support billing both codes.


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## themaid174@gmail.com (Aug 14, 2014)

Thank you so much!


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