Anesthesia Coding Alert

Question: Anesthesia was given when a patient had a trigger point injection because the patient had a great fear of needles and was so anxious about the procedure. Would either 00300 or 00400 be appropriate with 20552?

New Hampshire Subscriber

Answer: The trigger point injection itself includes a local anesthetic and doesn’t normally require anesthesia in conjunction with administration. The provider should only report 20552 (Injection[s]; single or multiple trigger point[s], 1 or 2 muscle[s]) for the therapeutic injection.

The only possible exception would be if another provider who plans to administer the injection requests anesthesia from another provider. In that situation you would need clear documentation of the request for anesthesia and still might receive a denial. The codes you reference – 00300 (Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified) and 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified) – might be appropriate, depending on the circumstances.

Here’s what happens: According to CPT^® guidelines, the patient is prepped and the injection site is anesthetized by spray. The provider palpates the muscle to determine the trigger point location. Once found, the provider applies firm pressure to the trigger point to assess for referred pain and a twitch response. Upon confirmation, the provider slowly injects the appropriate amount of corticosteroid or anesthetic into the trigger point.