ED Coding and Reimbursement Alert

Question: If the ED physician performs trigger point injections (TPIs) to alleviate pain, how do I code for the injection(s)?

Massachusetts Subscriber

Answer: TPIs can be tricky, because you have to count the number of muscles your provider injected — not the number of injections overall — to correctly code TPIs.

If the physician injects one or two muscles, report 20552 (Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)). You’ll report this code regardless of the number of times the physician injects the muscles. So, if they perform two TPIs on the patient’s left shoulder and two on their left elbow, you’d report 20552 with modifier LT (Left side) appended to indicate laterality.

If the physician injects three or more muscles, report 20553 (… 3 or more muscles). You’ll report this code regardless of the number of times the physician injects the muscles. So, if they perform one TPI on the patient’s left shoulder, one on their left wrist, and one on their left elbow, report 20552 with modifier LT (Left side) appended to indicate laterality.