Neurology & Pain Management Coding Alert

Question: What constitutes a "muscle group" as defined by trigger point injection codes 20552 and 20553?

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Answer: CPT introduced 20552 (Injection; single or multiple trigger point[s], one or two muscle group[s]) and 20553 ( three or more muscle groups) in 2002 to supplement 20550* (Injection; tendon sheath, ligament, ganglion cyst). What is not clear from the CPT definition, however, is whether an injection to each individual muscle (for example, to the left biceps and another to the left deltoid) counts as separate muscle "groups."

In fact, there are eight muscle groups:
1. head
2. cervical spine
3. left upper extremity, including shoulder
4. right upper extremity, including shoulder
5. thoracic spine
6. lumbosacral spine
7. left lower extremity, including hip
8. right lower extremity, including hip

All multiple injections in one of these body regions count as one unit of the injection. For example, if the physician administers three injections to muscles in the cervical spinal region, you should bill only one unit of 20552. If the physician administers two injections in the left shoulder, one injection in the cervical spine and two injections in the thoracic spine, however, you may report 20553 because three muscle groups were targeted.

If the physician targets more than three muscle groups, only a single unit of 20553 is appropriate. You may not, for instance, report one unit of 20552 to describe one muscle site and one unit of 20553 to code the other three muscle sites. In the past, when the physician injected more than one site, you could report 20550-59 (Distinct procedural service) to indicate the subsequent trigger point injections for additional sites. This is no longer the case: Because the descriptor for 20553 specifies "three or more muscle groups," you must report any number of muscle groups over three with a single unit of 20553.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; and Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, consultant and CPC trainer for A+ Medical Management and Education, Absecon, N.J.