Anesthesia Coding Alert

Question: I’m coding for an injection to the rectus abdominal muscle sheath. Would 20552 or 64999 be more appropriate? Alabama Subscriber

Answer: It appears that you’re referring to a trigger point injection into the muscle of the area rather than into the nerve. If so, remember the guidelines for reporting trigger point injections, or TPIs. For example, you code based on the number of muscles your provider administered injections to: 20552 (Injection[s]; single or multiple trigger point[s], 1 or 2 muscle(s)) or 20553 (…single or multiple trigger point[s], 3 or more muscle[s]). Always keep a record of which muscles your provider injects. Also note that 20552 and 20553 are “per session” codes – you’ll only need one code for the treatment, based on the number of muscles involved.

If you research further and determine that your provider was not administering trigger point injections, your best option might be 64999 (Unlisted procedure, nervous system). Submit the claim with thorough documentation of the service.

Explanation: An injection to the rectus abdominis muscle sheath was initially used to relax the patient’s abdominal wall muscle during laparotomy before other neuromuscular blocks became available. Now the rectus abdominal block is used for analgesia after umbilical or incisional hernia repairs and other midline surgical incisions.

The provider uses the injection to block the terminal branches of the ninth, tenth, and eleventh intercostals nerves that run between the internal oblique and ransverse abdominis muscles to penetrate the posterior wall for the rectus abdominis.