Anesthesia Coding Alert

Question: A patient received an injection of Bupivacaine for pain in the right lower quadrant of the rectus abdominus muscle. The physician coded it as a trigger point injection, but this muscle group is not identified in the Medicare policy as a site for trigger point injections. Should it be coded as a trigger point injection, or as a pain block? If we code it as a pain block, which code would be appropriate?

Washington Subscriber

Answer: Because the muscle is not listed in the Medicare LMRP as a trigger point site, to bill it as such would be fraud. Instead, bill the procedure as a block with code 64999 (Unlisted procedure, nervous system), rather than as a trigger point injection, and bill the Bupivacaine with J2000 (Injection, lidocaine HCl, 50 cc).