Anesthesia Coding Alert

Question: The physician completed a periligamentous block to C6- C7 and C7-T1 with manual mobilization. How should we code this since he accessed two different areas?

Answer: The description sounds like the provider administered the block around the ligaments, which leads to CPT 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar "fascia"]). Begin your coding by checking how many separate and distinct (and which) ligaments your provider injected. For example, you must have documentation of two separate ligament injections before reporting two units of CPT 20550.

Notice: Code 20550's descriptor states "injection(s)," which means the code applies to single or multiple injections to the same tendon sheath or ligament. Even if your provider administers multiple injections to the same tendon sheath or ligament, you only report 20550 once. Documentation that includes notations of separate tendon sheaths, ligaments, or other structures supports billing multiple units of service of 20550.

Complete the claim with CPT 97140 (Manual therapy techniques [e.g., mobilization/manipulation, manual lymphatic drainage, manual traction], 1 or more regions, each 15 minutes). Calculate the total length of manual mobilization time and divide by 15-minute increments to determine the number of code units.