Anesthesia Coding Alert

Question: How should I code deep muscle injections into the quadratus lumborum and psoas major muscles? California Subscriber Answer: Pain management providers may inject these muscles to treat myofascial pain. If your physician documents that he performed the injections for muscle trigger points, look at 20552 (Injection[s]; single or multiple trigger point[s], one or two muscle[s]). Another coding option might be 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular), particularly if your provider's documentation does not specify that he administered the injections to treat the muscle trigger points. Muscle anatomy: The quadratus lumborum muscle is one of the deep muscles in the lower back -- and is well known as a cause of lower back pain. Its action to bring the hip up is important for balancing postural distortion. The psoas muscles are also deep in the lower back on each side of the lumbar spine. They are part of the hip flexor muscle group that allows thigh flexion and lateral rotation. Tightness in the psoas major muscle can greatly limit low back mobility. It's a common source of low back pain in patients who have difficulty standing for extended periods or kneeling on both knees.