Neurosurgery Coding Alert

"Outpatient practices will probably report 64447 more frequently than the other new codes," Hammer suggests. As a single nerve block code, physicians might offer it to patients awaiting surgery, for example. "In the outpatient setting, I could foresee 64447 being used as a diagnostic tool to evaluate possible femoral nerve injuries," Hammer says.

The continuous infusion codes (64416, 64446 and 64448) will have more applications in postoperative pain management. Previously, physicians had to report these services using 64450* (Injection, anesthetic agent; other peripheral nerve or branch) and 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration). "The new codes carry a 10-day global period, and the instructions specifically indicate that 01996 should not be reported," Hammer says.

CPT 2003 modified several injection code descriptors to pinpoint more specifically the area injected. For example, the descriptor for 20550* eliminates the reference to the ganglion cyst and now states, "Injection(s); tendon sheath, ligament."


Similarly, descriptors for 20600* (Arthrocentesis, aspiration and/or injection; small joint or bursa [e.g., fingers, toes]) and 20605* (... intermediate joint or bursa [e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa]) also eliminate "ganglion cyst(s)." To compensate, CPTcreated a new code, 20612 (Aspiration and/or injection of ganglion cyst[s] any location). Areference following the descriptor for 20612 indicates that you should report multiple ganglion cyst aspirations and/or injections using 20612 with modifier -59 (Distinct procedural service) appended for the second and subsequent injections.

CPT 2003 offers new descriptors for 20552 (Injection[s]; single or multiple trigger point[s], one or two muscle[s]) and 20553 (... single or multiple trigger point[s], three or more muscles), which now specify "muscles" rather than the former "muscle group(s)." Physicians hoping that the revision will allow them to bill additional units of 20552 and 20553 for each muscle injected will probably be disappointed because as in past years these codes should be reported only one time per session, regardless of the number of injections or muscles injected.

The term "group(s)" was removed from 20552 and 20553 because physicians, coders and payers all faced confusion as to what constituted a muscle group, with obvious problems for reimbursement and coding consistency, says Allison Waxler, practice management policy analyst at the American Academy of Physical Medicine and Rehabilitation, one of the groups that worked with the CPTadvisory committee to effect the change.

"The codes are written to allow each code to be billed only once per day," Waxler explains. "One or more injections in one or two muscles should be coded with one unit of 20552. One or more injections in three or more muscles should be coded with one unit of 20553. Providers cannot bill multiple units of either code if multiple injections are given or if multiple muscles are injected."

For instance, if the surgeon administers three injections into the trapezius muscle, report one unit of 20552. If the surgeon performs three trigger point injections into the trapezius muscle, two injections into the supraspinal muscle and two injections into the paraspinal muscle, report one unit of 20553.