Eli's Rehab Report

Question: When I report multiple trigger point injections, should I ever code ultrasound guidance?


Wyoming Subscriber

Answer: If your physiatrist performs routine trigger point injections (such as 20552, Injection[s]; single or multiple trigger point[s], one or two muscle[s]), you may not have supporting medical necessity for using ultrasound guidance (such as 76942, Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation). You may have an argument if your physiatrist is using the ultrasound guidance for the very deep muscles, such as pyriformis. But keep in mind that you may have an uphill battle.

For example, Wyoming's Noridian local coverage determination (LCD) for trigger point injections states, "There is no laboratory or imaging test for establishing the diagnosis of trigger point; it depends upon the detailed history and thorough examination." This means that your payer may have cause to speculate when you attempt to report ultrasound guidance or imaging test in conjunction with a trigger point injection. You'll have to make clear the medical necessity of the ultrasound.