Anesthesia Coding Alert

Question: The Health Care Financing Administration (HCFA) policy on trigger point injections notes that a set may include up to eight separate injections. If one or more trigger points are treated within the same ICD-9 diagnosis code group, how should these be billed?

Anonymous CT Subscriber

Answer: Additional trigger point injections are billed using the -59 modifier (distinct procedural service not ordinarily performed or encountered on the same day by the same physician, but appropriate under certain circumstances such as with a different site or organ system, separate excision or lesion). It is not necessary for the trigger point injections to be performed on muscles in different ICD-9 code groups, but only on different muscle/trigger points. For example, if bilateral trigger point injections are performed on the trapezium muscles, the ICD-9 code of 723.9 (unspecified musculoskeletal disorders and symptoms referable to neck) would be used, and the two injections would be billed using 20550* on line one with 20550*-59 on line two.