Anesthesia Coding Alert

Question: I work with a physician who feels that CPT 20550* (Injection; tendon sheath, ligament, ganglion cyst) and 20551 (... tendon origin/insertion) should both be billed for the same injection. Yet, I struggle when I try to explain to him that an indented code includes part of the definition of the main procedure code and that the codes indicate distinct procedures. Would you help me with an easy explanation?

New Jersey Subscriber

Answer: The CPT manual introduction offers an explanation on the format of terminology. It states, "CPT procedure terminology has been developed as stand-alone descriptions of medical procedures. However, some of the procedures in the CPT book are not printed in their entirety but refer back to a common portion of the procedure listed in a preceding entry. This is evident when an entry is followed by one or more indentations. This is done in an effort to conserve space."

To determine the end of the definition of the common portion of the procedure, look for the semicolon. This signifies the point at which the indented entry phrase begins. For example, the full definition of code 20551 is Injection; tendon origin/insertion. With the full definition displayed, you can see that it would be inappropriate to bill both codes 20550 and 20551 for the same injection because the site of insertion is different.

Note that the CPT definition of code 20550 has changed for 2003. The new definition is Injection(s); tendon sheath, ligament. Injections and aspirations involving ganglion cysts are coded as 20612.

Responses to You Be the Coder and Reader Questions provided by Kelly Dennis, CPC, president of Perfect Office Solutions in Leesburg, Fla.; and Barbara Johnson, CPC, MPC, a professional coder at Loma Linda University Medical Group Inc. in Loma Linda, Calif.