General Surgery Coding Alert

When surgeons provide trigger-point injections, they may perform more than one injection in the same muscle group. The number of injections to be billed, however, does not depend on the number of injections performed.
 
Instead, carriers should be charged for the number of muscle groups that received trigger-point injections, experts say. Some carriers may not pay for more than one injection in any case, and others may pay for only a set number of injections, regardless of the number of muscle groups targeted.
 
If only one muscle group was targeted, only one injection may be charged, even if 10 or more injections were provided. Many carriers allow physicians to bill separately for each muscle group targeted as long as the different groups are documented and modifier -59 (distinct procedural service) is appended to all subsequent injections.
 
Trigger-point injections are used to treat acute or chronic pain in rigger points "" soft-tissue inflammations similar to planter's fascitis (an inflammation in the tendon of the foot). If the injection typically a steroid and often combined with an anesthetic agent provides immediate relief the surgeon knows the patient has a trigger point.
 
For example a surgeon may provide trigger-point injections to patients with severe groin pain. If there is no evidence of hernia but the patient exhibits tenderness in the abdominal wall or continues to have muscular pain the surgeon may perform a trigger-point injection in the area to see if it will relieve the patient's pain.
 
Similarly the surgeon may provide a trigger-point injection to a patient with a painful scar following surgery or to patients with carpal tunnel syndrome.
 
Required Modifiers 
Code trigger-point injections 20550 (injection tendon sheath ligament trigger points or ganglion cyst) says Kathleen Mueller RN CPC CCS-P an independent general surgery coding and reimbursement specialist in Lenzburg Ill. She notes that because 20550's descriptor includes the word ""points "" carriers -- commercial and Medicare -- interpret this to mean that the code includes more than one injection.
 
""It is inappropriate for surgeons to charge for every pressure-point injection they perform "" Mueller says. ""If you do three injections into the same muscle group in the groin for example that counts as only one injection. However if you do three injections into the groin and two more in a completely separate muscle group two injections may be billed.""
 
Many carriers limit the number of injections that may be billed even when different muscle groups are treated Mueller says. Most Medicare carriers will pay for a maximum of five injections during the same session although some carriers may reimburse as many as eight injections. Other states such as Alaska Arizona Hawaii Nevada Oregon and Washington pay for only one injection regardless of the number of muscle groups [...]