Radiology Coding Alert

Question: A patient suffered whiplash from crashing his car into a parked vehicle, and the physician performed trigger point injections to four sites to treat the condition. Based on our charge sheet, I reported 20552x2 and got a denial for the second code. Why? The descriptor for 20552 states “one or two muscle[s],” so I thought four muscles meant reporting the code twice.

Illinois Subscriber

Answer:  For four muscles, the appropriate code is 20553 (Injection[s]; single or multiple trigger point[s], 3 or more muscle[s]).

You should use 20552 (…single or multiple trigger point[s], one or two muscle[s]) for one or two muscles. Ensure your charge sheet includes both options so you may choose between them based on the patient’s case.

When you resubmit your claim, report a single unit of 20553 for all four trigger point shots. Also, remember to link ICD-9 codes 847.0 (Neck sprain) and E812.0 (Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle) to 20553 to represent the patient’s whiplash and the cause of the injury.