Anesthesia Coding Alert

Train physicians to clearly document the muscles--so you can code correctly

Your pain management specialist probably administers injections daily, but if you don't know your trigger point from your bursa, you could be noncompliant with every injection claim you submit.

The next time your specialist performs an injection, follow these four steps to pinpoint the appropriate code. 1. Don't Use 90772 as a 'Catchall'  Say the word "injection" to coders in some specialties, and they'll recommend 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) every time. But you have many more choices in a pain management practice, so don't automatically rely on 90772.

Flashback: Many coders used to rely on 90782 as a "catchall injection code," experts say. CPT 2006 deleted 90782 and introduced 90772--although you'll still steer clear in many cases because the descriptor remained the same.

If your physician doesn't document his injection clearly enough to select an appropriate trigger point or joint/bursa injection code, some coders might assign 90772 for the procedure. More experienced coders, however, say this is usually a bad idea and recommend checking with your provider for clarification.

Why it doesn't work: First, automatically assigning 90772 isn't correct coding because it doesn't follow CPT coding guidelines.

"It is not accurate coding if the procedure is something different from a simple therapeutic injection into a muscle, such as an injection of Toradol versus a procedure that requires higher physician work and malpractice risk," says Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver. And second, reporting 90772 every time costs the practice money. In 2007, Medicare reimburses about only $23 for 90772 in an office setting--compared to more than $50 for other common injection codes such as 20600 (Arthrocentesis, aspiration and/or injection; small joint or bursa [e.g., fingers, toes]).

When to use it: Report 90772 only if the physician administers a subcutaneous or intramuscular injection, such as a Demerol shot for a migraine headache or a Toradol injection as an anti-inflammatory. Otherwise, dig into the documentation to report a more accurate, site-specific injection code. 2. Bill 1 TPI per Muscle Group To report 20552 (Injection[s]; single or multiple trigger points[s], one or two muscle[s]) and 20553 (... single or multiple trigger point[s], three or more muscles) properly, you should know what you're dealing with. A trigger point is "a localized area of muscle that causes pain in a remote area when the muscle is firmly pressed on," Hammer says. If the physician documents an injection into a joint or ligament, for instance, he did not perform a trigger point injection (TPI).

Tip: Examine the physician's documentation to determine how many muscles he injected--don't simply count how many actual injections [...]