ED Coding and Reimbursement Alert

Remember to count muscles for accurate TPI count.

No matter what, the ED coders are going to come into contact with claims that require injection coding knowledge. That knowledge might not be complete for every coder.

In the ED, there are some injection procedures that are more common than others. Chemotherapy injections won’t likely be so common, though digital blocks will probably occur often. In the middle lie a few injections that aren’t as common in the ED — but could happen in ED settings.

We took the advice of Nate Felt, MS, ATC, PTA, CPC, senior consultant at Utah-based Intermountain Healthcare, on some of these injections you might likely to see at your ED, as well as some tips on reporting the CPT^® codes. Check out what he had to say.

Documentation Rules Similar for All Injections

Regardless of injection type, there are some pieces of documentation that you’ll need to include on each injection claim, Felt said during a recent webinar. All of this documentation should come in the form of a procedure note, in which you should document:

Where: Exactly where was the injection performed? Be as specific as possible. For example, don’t just report “injected ankle” when you could report “injected left posterior inferior tibiofibular ligament.”

How: How the patient responded to the injection? Specificity is your friend on this topic, too. For example, don’t report “patient was woozy” when you could report “patient could not stand on own for 5 minutes; complained of dizziness for 15 minutes and reported 6/10 pain at injection site.”

Check Out These Injection Codes

Felt ran down a few of the common injection codes you might see in the ED, along with some corresponding diagnosis codes/ procedure descriptions that might help your coding.

Injections you might see in your ED include:

• Codes: 20552 (Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)) and 20553 (…3 or more muscles)
• Procedure: This service involves “injecting an anesthetic or corticosteroid substance to relieve a trigger point, which is a painful area or knot in a muscle,” according to Codify by AAPC. When a trigger point is causing tenderness/weakness, restricting motion, and/or causing referred pain upon compression, it is likely considered medically necessary, Felt explained.
• Potential ICD-10 codes: Some of the codes that might prove medical necessity for 20552/20553 include:
• M54.2 (Cervicalgia)
• M54.5- (Low back pain)
• M54.6 (Pain in thoracic spine)
• M79.1 (Myalgia)
• M79.7 (Fibromyalgia)
•  
• Codes: 20600 (Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance) through 20611 (Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting)

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• Procedure: During arthrocentesis, “the provider inserts a needle through the skin of a patient and into a small joint or bursa and then uses the syringe attachment to the needle to remove fluid or he may inject a drug into the joint for therapeutic purpose. He performs this procedure without using ultrasound guidance,” per Codify by AAPC.
• Coding tip: The unit of service (UOS) for arthrocentesis codes is the joint and any surrounding bursa, Felt explained. The provider cannot report more than one UOS for arthrocentesis of a joint — even when the provider performs aspiration/injection to the surrounding bursae, Felt said.