Neurology & Pain Management Coding Alert

Document the muscle(s) the neurologists treats for clean injection coding

You may be submitting injection claims daily, but if you don't know your trigger point from your bursa, you could be shorting your practice up to $15 per injection.
 
Follow these three steps to pinpoint the appropriate injection code for your neurologist's services. 1: Don't Use 90782 as a 'Catchall' Say the word "injection" to most general practice coders, and they'll recommend 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular), but more often than not in neurology practice, you shouldn't rely on 90782.

"A lot of coders use 90782 as a catchall injection code," says Tammy Roesner, billing assistant at Forman Rehab in Illinois. "If the physician doesn't document his injection clearly enough to select an appropriate trigger point or facet joint injection code, the practice might assign 90782, but this is a bad idea." First, she says, automatically assigning 90782 isn't correct coding. And second, reporting 90782 every time costs the practice money because 90782 only reimburses about $26.

Don't forfeit reimbursement: "Practices can make up to $75 for some of the joint injection codes where I live," Roesner says. "Why would you risk losing this by submitting 90782 instead of the right code?" Report 90782 only if the physician administers a subcutaneous or intramuscular injection, such as a Demerol shot for a migraine headache. 2: Bill 1 TPI per Muscle Group To report 20552 (Injection[s]; single or multiple trigger points[s], one or two muscle[s]) and 20553 (...single or multiple trigger point[s], three or more muscles) properly, you should know that a trigger point is a muscle or fascia. If the physician documents an injection into a joint or ligament, for instance, he did not perform a TPI.

Tip: Examine the neurologist's documentation to determine how many muscle groups he injected - don't simply count how many actual injections he performed.
 
For instance, back-pain (724.5) patients typically have discomfort that originates in one muscle group, but they may feel discomfort throughout their back and in other parts of the body, such as the legs and neck. If your neurologist treats the pain with multiple trigger point injections and focuses on just one muscle, you cannot bill for each injection.

For example: Suppose the back-pain patient also complains that her arms and legs ache. During the examination, the neurologist discovers three trigger points in the multifidus muscle to the left of the L5 spinous process. The physician injects each trigger point in the multifidus muscle. You should report 20552 because the physician treated only one muscle (multifidus), even though he administered three injections. Back Multiple Injections With Documentation If you report 20553, the documentation should reflect that the neurologist injected multiple muscles. For [...]