Anesthesia Coding Alert

Hundreds of associated conditions make clearing through the clutter imperative.

Injection procedures are common fare for pain management specialists, which means you’d better know how to correctly select procedure codes and match diagnoses. Keep your claims for three go-to procedures on track with advice from Nate Felt, MS, ATC, PTA, CPC, of Intermountain Medical Group, and Judith L Blaszczyk, RN, CPC, ACS-PM, ICDCT-CM, compliance auditor at ACE, Inc. in Overland Park, Kansas.

Narrow the Potential Diagnoses for Tendon Sheath Injections

One of the most common injection procedures you’re likely to see is the tendon sheath/ligament shot, which Felt says is commonly used to treat conditions like trigger finger, tennis elbow, Achilles tendonitis, and distal bicep tendonitis.

Code choice: You’ll report a tendon sheath or ligament injection with 20550 (Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar “fascia”)).

Chalk up this injection’s frequency to its versatility; your provider can perform it on any tendon sheath in the body. A tendon sheath, Felt says, “is a layer of synovial membrane around a tendon. It permits the tendon to stretch and not adhere to the surrounding fascia.”

Translation: Any tendons in any anatomical area are potential 20550 targets.

For example, one Local Coverage Determination (LCD) reports more than 500 ICD-10-CM codes that are approved diagnoses for 20550. A few of these include:

• M25.3XX (Other instability of joint)
• M75.2X (Bicipital tendinitis)
• M76.0X (Gluteal tendinitis)
• M76.3X (Iliotibial band syndrome)
• M76.6X (Achilles tendinitis)
• M76.7X (Peroneal tendinitis)
• M77.0X (Medial epicondylitis)
• M77.1X (Lateral epicondylitis)

Note: This is not a definitive list. Check your LCDs for acceptable diagnoses for 20550.

Count Muscles to Pinpoint the Correct TPI Code

One of the standard injection services is the trigger point injection (TPI). As with the tendon/sheath shot, your provider can use TPI to provide treatment in a multitude of anatomical areas, and for many different conditions.

The most common diagnoses for TPIs are muscle pain, myalgia, fibromyalgia, and myofascial pain syndrome. “Muscle spasm is also frequently reported,” Blaszczyk explains.

When you’re reporting TPIs, you’ll use the following codes, depending on encounter specifics:

• 20552 (Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s))
• 20553 (Injection(s); single or multiple trigger point(s), 3 or more muscles)

Focus on muscles, not shots: As you’ll see from the code descriptors, you’ll choose a TPI code based on the number of muscles your provider injects — not the number of injections the provider performs on a muscle. For this reason, “it is very important that the physician document each muscle that is injected so the coder can select the correct code,” reminds Blaszczyk.

Since trigger points may occur in any skeletal muscle, almost any skeletal muscle may be injected. One LCD lists the following ICD-10-CM codes as acceptable diagnoses for TPIs:

• M54.2 (Cervicalgia)
• M54.5 (Low back pain)
• M54.6 (Pain in thoracic spine)
• M79.1 (Myalgia)
• M79.7 (Fibromyalgia)

Note: As with tendon sheath injections, this is not a definitive list. Check your LCDs for which codes are acceptable diagnoses for TPIs.

Base CT Injection Diagnosis on Location

One of the higher-paying — though rarer — injection services in your office is likely to perform is a carpal tunnel (CT) injection, according to Felt. You’ll report this service with 20526 (Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel).

You won’t see many 20526 claims because the shot is designed to treat a single condition: carpal tunnel syndrome (CTS). Thus, CTS diagnosis codes are probably the only ones you’ll be using to report 20526. Here are the CTS ICD-10 codes that will prove medical necessity for 20526, depending on encounter specifics:

• G56.01 (Carpal tunnel syndrome, right upper limb)
• G56.02 (Carpal tunnel syndrome, left upper limb)
• G56.03 (Carpal tunnel syndrome, bilateral upper limbs)

Remember: No matter which type of injection claim you’re filing, your success can hinge on how thoroughly your provider documents the service. Felt says documentation for all injection claims should include answers to the following queries:

• What drug was injected and in dosage?
• Where was it injected? (Be as specific as possible.)
• How did the patient respond to the injection?