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Anesthesia Coding Alert

Count the Muscles for New TPI Coding

Published on Sat Mar 01, 2003

 New descriptors for trigger point injections (TPIs) have changed pain management coding in 2003. "Last year, the codes were based on the number of injections within the muscle groups," says Tonia Raley, CPC, of Medical Information Management Solutions in Phoenix. "This year the codes include single or multiple injections within the muscles, limiting the number of times the codes can be billed." 

 Consider this example from Raley and Carla Thibodeaux, CPC, of Excel Practice Management in San Antonio, regarding how the new descriptors affect coding.       

 
  • In 2002, you used 20552 (Injection; single or multiple trigger point[s], one or two muscle group[s]) to report injections to one or two muscle groups and 20553 for three or more muscle groups. (CPT recognized the groups as head; cervical spine; right-upper extremity, including shoulder; left-upper extremity, including shoulder; lumbosacral spine; right-lower extremity, including hip; left-lower extremity, including hip; and thoracic spine.) If the physician injected one cervical spine muscle and three separate muscles in the right-lower extremity, you would have coded the procedure as 20552. (The doctor treated two muscle groups cervical spine and right-lower extremity, including hip so both were covered by 20552.) If the physician performed multiple injections to any of the muscle groups, you would list the appropriate code again.
  • In 2003, 20552 represents one or two muscles (instead of muscle groups), and 20553 represents three or more muscles. You would now code the above example as 20553. (The doctor treated four muscles total one in the cervical spine area and three in the right-lower extremity so these are covered by 20553.) You should no longer separately report multiple injections to the same muscle.

    Some carriers require documentation of the specific muscles injected during the procedure. Look for terms such as "external oblique," "lower thoracic," "brachialis anticus," "serratus posterior," "longissimus thoracis," "iliocostalis," "multifidus" or "rectus abdominalis" in the operative report to point you in the right direction.

    Thibodeaux and Raley agree that the new distinctions can be confusing because you're accustomed to coding for muscle groups instead of individual muscles and carriers might interpret the descriptors differently. Talk with your carriers, read the procedural notes carefully, and pay attention to distinctions between groups and muscles to ensure that you're using the revised codes correctly.

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