Orthopedic Coding Alert

Question: This year, the new trigger point injection (TPI) codes were introduced (20552-20553), but I'm still not sure how to use them. For instance, if I perform 13 total TPIs to six muscle groups, should I code 13 units of 20553 (Injection; single or multiple trigger point[s], three or more muscle groups), or just two (to signify the six sites)?

Georgia Subscriber

Answer: You should only bill one unit of 20553, regardless of how many total TPIs the orthopedist performed. The descriptor for 20553 reads, "three or more muscle groups," and, therefore, six muscle groups would fall into the "or more" category. Unfortunately, the new codes do not allow for extra reimbursement when the physician injects more than three muscle groups.

Some practices have tried to get around this new coding method by billing multiple units of 20552 (Injection; single or multiple trigger point[s], one or two muscle groups). For instance, if the orthopedist injected six muscle groups, the practice reports six units of 20552. This is not correct coding, and payers will not reimburse you for the additional units. Even if carriers make a mistake and pay you extra for the subsequent units billed, you would be at risk if an audit reveals your way of trying to increase your reimbursement.

If you inject one or two muscle groups, use 20552, and if you inject any more than two, bill 20553.