Question: The physician performs a history and physical exam and expresses concern that the patient may have a herniated cervical disc in addition to muscle strain. He orders an MRI of the cervical spine and prescription pain killers. In his exam, he also found several trigger points in the trapezius and scalene muscles. He injects the trigger points to give the patient more immediate relief. Final diagnosis is "torticollis NOS." In this situation, are the injections separately reportable, or is the TPI part of the E/M service? Answer: 20552 (Injection[s], single or multiple trigger point[s], 1 or 2 muscle[s]) for the TPI The appropriate level ED E/M code (99281-99285, Emergency department visit for the evaluation and management of a patient, which requires these 3 key components ...) depending on encounter notes Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to the E/M to show that the E/M and the TPIs were separate services 723.5 (Other disorders of cervical region; torticollis, unspecified) appended to 20552 and the E/M code.