Neurology & Pain Management Coding Alert

Question: When reporting multiple trigger-point injections, I use 20550 and change the units to the number of injections the patient received for each muscle group. Is this correct?

Oregon Subscriber  
Answer: No. The insurer will not pay for duplicate injection services, which is what you are indicating by billing multiple units of a single procedure code.
 
Trigger-point injections are reported according to the muscle groups targeted, not the number of injections, i.e., multiple injections performed at the same site are considered a single injection. Until the release of CPT 2002, if more than one muscle group was injected, the additional injections were reported using 20550 (defined below) with modifier -59 (distinct procedural service) appended, although some carriers preferred modifier -51 (multiple procedures).
 
For 2002, 20550 was revised and four new injection codes were introduced:

20526 injection, therapeutic (e.g., local anesthetic; corticosteroid), carpal tunnel
20550 injection; tendon sheath, ligament, ganglion cyst
20551 ... tendon origin/insertion
20552 ... single or multiple trigger point(s), one or two muscle group(s)
20553 ... single or multiple trigger points(s), three or more muscle groups.  
According to CPT Changes 2002, the new codes were established To differentiate the techniques associated with multiple muscle group injections for trigger points. Nevertheless, the correct code is still chosen according to the number of muscle groups targeted, not the number of injections. Choose 20552 if one or two muscle groups are injected. Choose 20553 if three or more are injected. Code 20550 should be used to describe injections to a tendon sheath, ligament or ganglion cyst.
 
Code 20551 was established to describe therapeutic injection of a tendon at its origin/insertion. Code 20526 is for therapeutic injections (e.g., steroid injections, including cortisone or other drugs) to the anatomic space of the carpal tunnel.
 
When billing 20526-20553, you must document  medical necessity for the injections (as opposed to more conservative treatments such as physical therapy, heat, massage, etc.), as well as an acceptable, verifiable diagnosis, which varies by carrier.