ED Coding and Reimbursement Alert

Question: A patient suffers whiplash from crashing his car into a parked vehicle, and the ED physician performs trigger point injections to four sites to treat the condition. I reported 20552x2 and get a denial for the second code. Why? The descriptor for 20552 states "one or two muscle[s]," so I thought four muscles meant reporting the code twice.

Illinois Subscriber

Answer: You are in the right code set, you just picked the wrong trigger-point injection code. While you should use 20552 (Injection[s]; single or multiple trigger point[s], one or two muscle[s]) for one or two shots, the correct choice for three or more shots is 20553 (… single or multiple trigger point[s], three or more muscle[s]).

So when you re-submit your claim, report 20553 for all four trigger point shots. Also, remember to link ICD-9 codes 847.0 (Sprains and strains of other and unspecified parts of back; neck) and E812.0 (Other motor vehicle traffic accident involving collision with motor vehicle; driver of motor vehicle other than motorcycle) to 20553 to represent the patient’s whiplash and the cause of the injury.