Anesthesia Coding Alert

Question: Our physicians insist on billing for each trigger point injection they administer, no matter how many. Insurance companies will not pay for them, even when we include copies of the patient's record. Which is the best way to bill for reimbursement?

Minnesota Subscriber
 
Answer: Many carriers pay for only one trigger point injection per day, but others -- including some Medicaid programs -- have guidelines that allow payment for more. In this case you will probably get higher reimbursement for the primary injection, and even smaller amounts for subsequent injections. Billing for trigger point injections has many variables, so ask your carriers for guidelines to help you file claims accurately and follow up on incorrect denials. The primary code for trigger point injections is 20550* (injection, tendon sheath, ligament, trigger points or ganglion cyst). 

Because it is a starred procedure, remember to bill an appropriate E/M code for the visit. Most carriers will not pay for an unlimited number of trigger point injections, so verify what they will pay for during a visit. Some carriers might also require modifier -51 (multiple procedures) after the first injection, so verify that policy as well.