Anesthesia Coding Alert

Check your carriers' diagnosis code listings to ensure accuracy You're coding for accuracy, not for dollars, but it's frustrating when a carrier doesn't include particular diagnoses in its list of medically necessary circumstances for procedures. Now some coders have some good news regarding acceptable diagnoses: Blue Cross/Blue Shield of Montana recently updated its LMRP on trigger point and tendon, ligament and ganglion cyst injections to expand your coding choices.
 
The policy doesn't change anything related to trigger point injections, but it adds two diagnosis codes that support medical necessity for tendon, ligament and ganglion cyst injections:
  724.1 - Pain in thoracic spine
  724.2 - Lumbago. These diagnoses now support medical necessity for:
20526 - Injection, therapeutic (e.g., local anesthetic, corticosteroid), carpal tunnel
20550 - Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar "fascia")
20551 - ... single tendon origin/insertion. The additional diagnosis codes will help providers achieve more appropriate reimbursement in some situations, says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting in Denver. "Both of the new diagnoses could possibly be used to report 20550 for spinal ligament injections. Some tendon origins and insertions are located along the spinal vertebrae, so the new diagnoses could also apply to 20551. The challenge is that the provider's documentation often doesn't specifically indicate the origin/insertion as the anatomic structure they are injecting so you know to report 20551."
 
Obviously, physicians will rarely use lumbago or thoracic spine pain as diagnoses in conjunction with a carpal tunnel injection (20526). Hammer's theory is that Aetna might group the three injection codes together for LMRP purposes because they are similar procedures. That would mean the ICD-9 codes get linked with all three injection codes even if they don't support a carpal tunnel injection. Expect These Injections for Common Injuries Physicians often perform tendon or ligament injections to treat rheumatism, fibromyalgia and other chronic conditions, says Cindy Clark, CPC, anesthesia coding supervisor with Anesthesiology Consultants in Savannah, Ga. Other common diagnoses that support these injections include 726.39 (Enthesopathy of elbow region; other), 726.71 (Achilles bursitis or tendonitis) and 726.90 (Enthesopathy of unspecified site).
 
"We see tendon injections more frequently in sports-related or 'weekend warrior' type injuries," Hammer adds. "Physicians frequently use them to treat tendonitis (727.00-727.9), tennis elbow (726.32, Lateral epicondylitis) or golfer's elbow (726.32)."
 
Hammer's physicians perform a "moderate amount" of ligament injections. Physicians use them to help accident-type injuries and sprains or strains of knees, ankles, low back or other joints (840.0-848.9). Patients receive ganglion cyst injections least often, primarily for problems in their fingers or wrists. Patients May Have Single or Multiple Injections Some patients have relief after only one injection, but others need a series of injections. "Patients typically have a [...]