Primary Care Coding Alert

Question: When reporting CPT^® 20550, should I report the code with bilateral modifiers if administered bilaterally. If the injections are provided on different sites, should a modifier be used? Do I need to bill each on separate line items with modifiers? Or do I put 1 on a line item and change the unit to 2?

Michigan Subscriber

Answer:  When your physician administers a corticosteroid, anesthetic, or anti–inflammatory drug to a single tendon sheath or ligament, you report the CPT^® code 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar “fascia”]). You report only one unit of the code if your clinician administers multiple injections to the same tendon sheath or ligament.

You can report multiple units of 20550 if your physician administered the injection into multiple sites. However, in order to differentiate and inform the payer that your clinician administered the injection into multiple sites, you will have to use the appropriate modifiers.

When reporting multiple units of 20550 administered bilaterally, you can report it with the modifier 50 (Bilateral procedure) to indicate that the procedure was repeated on the same joint on the other side. However, if your clinician is administering the injections in multiple sites, you will have to report 20550 for the first injection and report the additional injections in other sites using the modifier 59 (Distinct procedural service) appended to 20550.

You report the first unit of the injection administered in line 1 of the CMS-1500 claim form and report the additional units of the code with the appropriate modifier in the second line. You also need to specify which joints your clinician administered the injections into in the CMS-1500 form. You have to report this in box 19 of the claim form or include the designations with the procedure code to let the payer know which of the joints your clinician administered the injections.