Anesthesia Coding Alert

Question: Medicare recently denied one of my claims for trigger point injections on the grounds that the treatment was not medically necessary. I had coded 20550* (injection, tendon sheath, ligament, trigger points or ganglion cyst) for the first injection, and 20550-51 for the other five injections. The diagnosis on my original bill was 729.1 (myalgia and myositis, unspecified). I resubmitted it with diagnosis 724.2 (low back pain) and was denied again. Weve never run into this situation before. Have some of the rules for multiple trigger point injections changed? How would you recommend that we code it?

Anonymous California Subscriber


Answer: This can happen frequently to anesthesiologists. When it does, send it to Medicare Review, which requires a completed Medicare Review form and a hard-copy claim and documentation of the medical necessity of the trigger point injection. The documentation can be the doctors dictation from the procedure and/or earlier office visits detailing the patients condition. Diagnosis code 729.1 is correct for most trigger point injections, so you should leave that code on the claim. Medicare usually pays the claim after reviewing this data.