Anesthesia Coding Alert

Pain Management:

Tackle TPI Injections in No Time Using This Quick Primer

Published on Mon Jan 09, 2023

Muscles or injections? Here’s what number matters for coding.

You have a lot to remember when reporting trigger point injections (TPIs), and it doesn’t stop with finding the correct code for the injection itself. Check out this tried-and-true advice on getting your TPI coding right the first time.

What Is a Trigger Point?

“Trigger points are sensitive areas within the connective tissue — also known as fascia — and/or bands of muscle that have become hypersensitive with pain due to compression,” explains Yvonne Dillon, CPC, CEDC, manager of coding documentation at ZOTEC Partners in Carmel, Indiana. “When pressing on a trigger point, referred pain can be caused. This helps identify the part of the body that is generating the pain.”

Providers often identify trigger points during an office/ outpatient evaluation and management (E/M) service, which you should report using the appropriate code from 99202-99205 (Office or other outpatient visit for the evaluation and management of a new patient …) or 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient …).

According to Dillon, trigger points can also be “formed by acute or repetitive trauma to the muscle tissue, which puts too much stress on the fibers.” They can be “at different places in both skeletal muscles in the hip, neck, shoulder. They are usually in places where nerves connected the muscle fibers.”

Dillon says that the following conditions could necessitate a TPI:

Spasms
Tendonitis/bursitis
TMJ joint disorders
Osteoarthritis or other joint dysfunction
Nonmyofascial tender points
Myalgias
Fibromyalgia
Tension-type headaches
Gout
Psoriatic arthritis
Rheumatoid arthritis
Neuralgias
Other soft tissue disorders related to overuse and pressure or the extremities

Tip: There are too many ICD-10-CM codes to list under each of these broad diagnoses, and this is not a comprehensive list of all the conditions that could warrant a TPI. Always check with your payer for their policy on acceptable diagnoses for TPIs.

There will be a core of commonality among all payers, but there might also be some differences as to which ICD-10-CM codes each payer accepts to support medical necessity. You must report a code based on the documentation, not based on what the payer will cover, and checking the payer’s list of codes will let your practice and your patient know what to expect when you submit the claim.

Count Muscles, Not Injections, for TPI Code Selection

When your provider decides to perform a TPI, coding is fairly straightforward — but don’t miss out on the details or you could end up miscoding.

Why? There’s a little trick to coding TPIs. The number of actual injections isn’t relevant; you’ll choose a TPI code based on the number of muscles injected, not the number of injections, says Jessica Miller, MHA, CPC, vice president of revenue cycle at Ortmann Healthcare Consulting Services in South Carolina.

Report TPIs using 20552 (Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)) or 20553 (… single or multiple trigger point(s), 3 or more muscles).

Example 1: Encounter notes indicate that the provider performed TPIs on the longissimus and iliocostalis muscles. The provider injected the longissimus four times and the iliocostalis five times. For this encounter involving two muscles, you’d report 20552 because it applies to TPI of one or two muscles.

Example 2: Encounter notes indicate that the provider performed TPIs on the longissimus, iliocostalis, multifidus, and quadratus muscles. The provider injected all the muscles once. For this encounter, you’d report 20553 because it applies to TPI of three or more muscles.

Turn to Code Notes Before Reporting Additional Services

Notes with 20552 and 20553 reveal some restrictions to observe when reporting. According to CPT^®, you cannot report a TPI and the following codes for the same muscle(s):

20560 (Needle insertion(s) without injection(s); 1 or 2 muscle(s))
20561 (… 3 or more muscles)

The 20552 and 20553 notes also provide some exceptions that allow coding for certain services. If the provider uses imaging guidance during the TPI, CPT^® allows coding for it in certain forms.

According to CPT^®, you can report these imaging guidance codes if the services are performed in conjunction with a TPI:

76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation)
+77002 (Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure))
77021 (Magnetic resonance imaging guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation)

Capture J Codes for Accurate Payment

Coders need to remember to check each TPI report for any drugs that the provider might have injected, Miller says.

When the provider performs a TPI, they will inject a drug, typically a steroid or corticosteroid. To account for the cost of the drug supply, you can use HCPCS Level II J codes.

Some of the drugs your provider might inject during a TPI, and their corresponding J codes, include:

Betamethasone: J0702 (Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg)
Prednisolone: J2650 (Injection, prednisolone acetate, up to 1 ml)
Methylprednisolone: J2920 (Injection, methylprednisolone sodium succinate, up to 40 mg)

Remember: Base your coding on the documentation and confirm coverage of specific codes and drugs by checking payer policy.