Anesthesia Coding Alert

Pay attention to all the options for reporting the drug.

If you ever code for pain management services, you should be quite familiar with trigger point injection (TPI) claims. Maximizing your claim includes knowing whether to separately report the drug supply from the actual injection(s). Refresh your knowledge with this rundown of TPI supply rules and common TPI anatomy.

Turn to J Codes for TPI Dose in Most Cases

When your provider performs a TPI, you should be able to code separately for drugs, says Yvonne Dillon, CPC, CEDC, a coding consultant in Indianapolis, Indiana. “For instance, the HCPCS J codes may be utilized to capture the steroid or corticosteroid medication,” she says.

Any of these drugs are commonplace for providers administering a TPI:

• Bethamethasone (Celestone^®): Report with J0702 (Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg)
• Prednisolone (Prelone^®): Report with J2650 (Injection, prednisolone acetate, up to 1 ml)
• Methylpresnisone (Medrol^®, Depo-Medrol^®, Solu-Medrol^®): Report with one of four choices, depending on the situation:

o J1030, Injection, methylprednisolone acetate, 40 mg
o J1040, Injection, methylprednisolone acetate, 80 mg
o J2920, Injection, methylprednisolone sodium succinate, up to 40 mg
o J2930, Injection, methylprednisolone sodium succinate, up to 125 mg

Remember: This is merely a list of drugs your provider might use; don’t take it as gospel. Check with your providers about the drugs they use during TPIs, and check with your payers to see the TPI drugs they consider reimbursable.

Keep Muscle Knowledge Strong With TPI Watch List

In the CPT^® entry for TPIs, it lists several muscles that the provider might inject during a TPI: longissimus, iliocostalis, multifidus, quadratus, and psoas major. Those are not nearly the only muscles that might require TPI, experts say.

“There is no exact count of the number of muscles in the body largely because expert opinions are conflicted regarding what constitutes a distinct muscle,” explains Joanne Mehmert, CPC, CCS-P, president of Joanne Mehmert and Associates in Kansas City, Missouri. “Some say there are about 640 muscles,” she says, so you’ll need to refrain from compiling a complete list of anatomical targets for TPIs.

It wouldn’t hurt, however, to know a little about the more common TPI muscles. According to Deborah Messinger-Pellon, RHIT, CCS, CPC, CPMA, coding manager, Surgery & Anesthesia Team at Massachusetts General Physicians Organization/Professional Billing Office in Charlestown, Massachusetts, some of the more common muscles that fall victim to trigger points include:

• Masseter
• Scalene group
• Trapezius (upper and lower)
• Rhomboids
• Piriformis gluteus maximus
• Occipital ridge
• Levator scapulae
• Rotator cuffs
• Quadratus lumborum
• Gastrocnemius
• Soleus
• Plantaris
• Quadratus plantae (for plantar fasciitis).