Anesthesia Coding Alert

Question: Our pain management physician administered four coccygeal ligament injections. Should I code this as 20550 x 4, or should I only bill it once?

Maryland Subscriber

Answer: Coding guidelines for 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [eg, plantar “fascia”]) state that you can bill a maximum of five units within a day. However, pay attention to the descriptor; one unit of 20550 can represent either a single or multiple injections to the same tendon sheath or ligament. If all injections were administered to the same anatomic site, you can only report 20550 once.

If your physician administered the injections to multiple sites, you can report 20550 multiple times, up to a maximum of four. Appropriate use of modifiers will help support the claim.

• When reporting multiple units of 20550 administered bilaterally, you can report it with modifier 50 (Bilateral procedure) to indicate that the procedure was repeated on the same joint on the other side. However, if your clinician is administering the injections in multiple sites, you will report 20550 for the first injection and report the additional injections in other sites with modifier 59 (Distinct procedural service) appended to 20550.
• You report the first unit of the injection administered in line 1 of the CMS-1500 claim form and report the additional units of the code with the appropriate modifier in the second line. You also need to specify which joints your clinician administered the injections into in the CMS-1500 form. You have to report this in box 19 of the claim form or including the designations with the procedure code to let the payer know which of the joints your clinician administered the injections.