Orthopedic Coding Alert

Question: What is the difference between the codes in the 20550-20553 series? I know the description of 20551 is "tendon origin/insertion," but I'm not sure how that differs from the tendon sheath injection (20550) or the trigger point injections (20552-20553). Virginia Subscriber

Answer: A tendon is the fibrous collagen cord that attaches the muscle to bones or other structures. A synovial sheath may surround portions of a tendon. Tendon inflammation within the sheath causes pain or a decrease in joint mobility. A trigger finger (727.03) injection qualifies as a tendon sheath injection, and you should report it using 20550* (Injection[s]; tendon sheath, ligament).

A tendon origin is where the tendon attaches to the muscle proximally, and a tendon insertion is where the tendon attaches to the bone distally. For example, the quadriceps tendon origin is the quadriceps muscle, and its insertion is the tibial tubercle. The orthopedist might inject the origin of the extensor muscle group to treat lateral epicondylitis (726.32, Tennis elbow). You should report 20551 (Injection[s]; tendon origin/insertion) for this type of procedure. A trigger point is a hyperirritable tender spot in a muscle that "triggers" pain to other muscles. This is why neck muscles often cause head pain. These spots are usually in the muscle and its lining (fascia), and are also called "myofascial" trigger points. Orthopedists often inject anesthetic medication into the triggering muscle to treat trigger points.

Depending on how many muscles you inject, you should report one unit of either 20552 (Injection[s]; single or multiple trigger point[s], one or two muscle[s]) or 20553 (... single or multiple trigger point[s], three or more muscles) for trigger point injections.