ED Coding and Reimbursement Alert

Question: When the provider performs trigger point injections (TPIs), can you code separately for separate needle insertion, drug supply, or guidance?

North Dakota Subscriber

Answer: No, no, and yes. In the notes beneath the 20552 (Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)) and 20553 (…3 or more muscles) codes, there are some restrictions. According to CPT^®, you cannot report a TPI and the following codes for the same muscle(s):

• 20560 (Needle insertion(s) without injection(s); 1 or 2 muscle(s))
• 20561 (… 3 or more muscles)

You also cannot code for drug supply in the ED setting.

There are, however, also some exceptions that allow coding for certain services. If, the provider uses imaging guidance during the TPI, CPT^® allows coding for it in certain forms.

According to CPT^®, you can report these imaging guidance codes if the services are performed in conjunction with a TPI:

• 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation)
• +77002 (Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure))
• 77021 (Magnetic resonance imaging guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation)

If you are using equipment that the facility owns during the imaging — such as a magnetic resonance imaging (MRI) machine for 77021 — be sure to append modifier 26 (Professional component) to the guidance code.