Anesthesia Coding Alert

Question: Our physician did an epidural steroid injection (ESI) and trigger-point injection (TPI) on a patient at distinct sites. Should I bill 62311 and 20550*, and should I use modifier -51 or -59 on 20550?

Minnesota Subscriber  
Answer: Bill 62311 (Injection, single [not via indwelling catheter], not including neurolytic substances lumbar, sacral [caudal]) as the primary procedure because it pays more.
 
The TPI code should be listed as the secondary procedure with modifier -59 (Distinct procedural service); some carriers may prefer modifier -51 (Multiple procedures). However, in CPT 2002, the definition of 20550* has been revised to Injection; tendon sheath, ligament, ganglion cyst. It now applies only to superficial injections into soft tissue.
 
CPT 2002 also introduced two new TPI codes and two related codes:

  20526 Injection, therapeutic (e.g., local anesthetic; corticosteroid), carpal tunnel

  20551 Injection; tendon origin/insertion

  20552 single or multiple trigger point(s), one or two muscle group(s)

  20553 single or multiple trigger point(s), three or more muscle groups.  
Code 20526 can only be used with a diagnosis of carpal tunnel syndrome (354.0).
 
Some carriers require that the appropriate body-side modifiers -LT (Left side) or -RT (Right side) be appended to the code. Others may also require modifier -GA (Waiver of liability statement on file) if the patient has signed a liability statement. Floridas Medicare Part B carrier, First Coast Service Options, requires both modifiers because it is monitoring the use of these appended codes.
 
Carriers can take awhile to start processing claims using new and revised codes. Before submitting claims, check with your local Medicare carrier and private insurers to determine the best way to code these procedures.