ED Coding and Reimbursement Alert

Question: A patient with a history of back problems reports to the ED complaining of sharp lower back pain and aching legs. The physician discovers three trigger points in the patient's longissimus muscle, and performs therapeutic injections at each trigger point. Can I report 20553 for this encounter?

Indiana Subscriber

Answer: You cannot report 20553, because the physician treated only one muscle. CPT groups trigger point codes to reflect the number of overall muscles the ED physician treats, not how many injections he performs.

On the claim, report the following:

- 20552 (Injection[s]; single or multiple trigger point[s], one or two muscles) for the injections

- 724.2 (Lumbago) and 729.5 (Pain in limb) appended to 20552 to represent the patient's symptoms.

Report 20552 whenever the physician treats one or two muscles with injections, regardless of the number of shots. When the physician performs trigger points on three-plus muscles, you can report 20553 (- single or multiple trigger point[s], three or more muscle[s]).