Orthopedic Coding Alert

Question: In a patient who sustained whiplash injury in a road traffic accident, our ED surgeon performed trigger point injections in four sites. We reported 20552x2 and were denied payment for the second code. Please help us understand how we are wrong to report the second code. The descriptor for 20552 states “one or two muscle[s],” so for four muscles we reported the code twice.

Illinois Subscriber

Answer: You have made a correct choice of code set, but you just picked the wrong trigger-point injection code. While you should use 20552 (Injection[s]; single or multiple trigger point[s], one or two muscle[s]) for one or two shots, the correct choice for three or more shots is 20553 (… single or multiple trigger point[s], three or more muscle[s]).

So when you re-submit your claim, report 20553 for all four trigger point shots. Additionally, you should report ICD-9 codes 847.0 (Sprains and strains of other and unspecified parts of back; neck) and E812.0 (Other motor vehicle traffic accident involving collision with motor vehicle; driver of motor vehicle other than motorcycle) with 20553 to represent the patient’s whiplash and the cause of the injury.