Wiki 20550??

[sla696]

I have a provider wanting to bill 20550 x 6 and 20551 x 2. I appreciate any input. Thanks.

Patient presents to me today for followup examination. Unfortunately, the trigger points did not tremendously help this gentleman, so we will not go forward with any trigger point injections. However, his cervical spine pain is disabling him from doing any significant activities of daily living and pain-free, so we will go ahead with 2 cc of lidocaine 2% with no epinephrine and inject it into the bilateral C4-5, C5-6, and C6-7 paraspinal ligaments. Patient tolerated these procedures well. These 6 ligaments were injected under sterile condition.

The trapezius also seems to have bilateral trapezius tendinitis, so 0.25 cc lidocaine and 0.25 cc of Kenalog were injected along the bilateral trapezius tendons, and patient tolerated these 2 injections well.

 

[OCD_coder]

Documentation supports:
1. Bilateral 20550 x 3 - modifier 50

If the paraspinal ligaments injected into the cervical area were related to the trapezius muscles these bundle and cannot be coded separately as they are contiguous structures. But if you query the provider and ask what specific ligaments to the paraspinal muscle were injected and they were not the trapezius muscles, the documentation would really support a 20552-59 better than a 20551 as the documentation does not specify origin or insertion of the tendon. All of the other injection codes for trigger points, ligaments muscles etc bundle to the 20550.

Some coders may elect to report the a IM injection 96372 x 2 instead of the 20552. I feel the 20552 better reflects what as performed, but would not argue with the 96372. You can only bill the 20552 1 time per encounter after you total the number of muscles injected. This is not a bilateral code due to the # of muscles driving the code selection.