Anesthesia Coding Alert

Knowing how to submit claims correctly can ease your pain Coding for the diagnosis and treatment of whiplash is usually pretty straightforward, but you sometimes need to take extra care when coding, especially if the patient's symptoms persist despite conservative therapy and warrant more extensive treatment. Start With Conservative Treatment     When a patient presents with whiplash symptoms, your pain management specialist will conduct a thorough exam and will often order neck x-rays to rule out fractures.

First steps: Once the pain specialist diagnoses whiplash, he will try conservative treatment such as physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants. Some patients may also benefit from wearing a soft cervical collar or by using a portable traction device.

If conservative treatment fails, the physician may order additional diagnostic imaging tests. These include:

• CT scans -- 70490 (Computed tomography, soft tissue neck; without contrast material), 70491 (...  with contrast material[s]) and 70492 (... without contrast material followed by contrast material[s] and further sections)

• MRIs -- 70540 (Magnetic resonance [e.g., proton] imaging, orbit, face and neck; without contrast material[s]), 70542 (... with contrast material[s]) and 70543 (... without contrast material[s], followed by contrast material[s] and further sequences)

• Bone scans -- CT, MRI and x-ray tests include basic bone scans. If your physician orders more extensive bone scans for the patient, you might report 78300 (Bone and/or joint imaging; limited area) or 78305  (... multiple areas) instead.
 
Your physician might also administer trigger point injections to relieve the patient's pain and muscle tenderness. Code these procedures with 20552 (Injection[s]; single or multiple trigger point[s], one or two muscle[s]) or 20553 (... single or multiple trigger point[s], three or more muscles).

Caution: The difference between the two codes is the number of muscles the physician injects, not the number of injections he administers, says Marvel J. Hammer, RN, CPC, CHCO, president of MJH Consulting in Denver.  

The updated descriptors "clarified that if it is a different muscle and documented as such that the number of muscles may be counted to determine the difference between 20552 and 20553," adds Julee Shiley, CPC, a South Carolina coding consultant. "If, however, there are multiple injections within the same muscle, this is only to be counted as one trigger point injection, regardless of the amount of injections."

Further explanation: You'll have to use your best judgment in some trigger point cases because CPT does not have "official" definitions to clarify when to use each code. Some coders recommend following guidelines such as "muscles in close proximity with similar function" equal one muscle group (for example, the right elbow flexors are one group, extensors are another group). If your pain specialist injects two muscles near each other with similar function, he [...]