nlbarnes
Expert
Hello - there is a bundling edit for 20606 & 20552. 20606 being in the TMJ and with 20552 in the masseter muscle.
I don't understand why there would even be the edit for needing to be unbundled from a clinical standpoint as it seems that it is 2 separate structures?
Or, if you were to unbundle, what would the reason be from a clinical standpoint vs if it isn't able to be unbundled. I'm lacking clinically in that for these 2 codes together.
I'd like to understand more in case I need to query the provider and/or apply a modifier.
Procedure Note:
Approach: An out of plane approach was used.
Injection: The area was prepped in a sterile fashion with Chlorahexidine and Isopropyl alcohol. Using sterile technique with a sterile probe cover, the temporomandibular joint was visualized in the short axis under real time ultrasound with a 13-87 megahertz linear array transducer.
Using sterile technique, a 27 gauge 1 1/2 inch needle was advanced slowly until the temporomandibular joint was identified and 1 milliliters of a combination of 0.5 ml 1% Lidocaine and 1ml 40 milligrams (40mg/ml) of Kenalog was injected into the joint space.
A permanent ultrasound image has been stored in our imaging system.
OPERATIVE NOTE:
Trigger point injections- masseter
The area was sterilized with Chloraprep. A 27 gauge, 1.25 inch needle was used for injection into the trigger points. Approximately 0.5 milliliters of a combination of 0.5 ml 1% Lidocaine and 1ml 40 milligrams (40mg/ml) of Kenalog was injected into each of trigger points in the above muscles. Each trigger point was subsequently massaged for better diffusion of the anesthetic. Patient tolerated the procedure well. There were no complications.
Outcome: Successful ultrasound guided injection of the temporomandibular joint and trigger point injections. The needle placement was confirmed.
I don't understand why there would even be the edit for needing to be unbundled from a clinical standpoint as it seems that it is 2 separate structures?
Or, if you were to unbundle, what would the reason be from a clinical standpoint vs if it isn't able to be unbundled. I'm lacking clinically in that for these 2 codes together.
I'd like to understand more in case I need to query the provider and/or apply a modifier.
Procedure Note:
Approach: An out of plane approach was used.
Injection: The area was prepped in a sterile fashion with Chlorahexidine and Isopropyl alcohol. Using sterile technique with a sterile probe cover, the temporomandibular joint was visualized in the short axis under real time ultrasound with a 13-87 megahertz linear array transducer.
Using sterile technique, a 27 gauge 1 1/2 inch needle was advanced slowly until the temporomandibular joint was identified and 1 milliliters of a combination of 0.5 ml 1% Lidocaine and 1ml 40 milligrams (40mg/ml) of Kenalog was injected into the joint space.
A permanent ultrasound image has been stored in our imaging system.
OPERATIVE NOTE:
Trigger point injections- masseter
The area was sterilized with Chloraprep. A 27 gauge, 1.25 inch needle was used for injection into the trigger points. Approximately 0.5 milliliters of a combination of 0.5 ml 1% Lidocaine and 1ml 40 milligrams (40mg/ml) of Kenalog was injected into each of trigger points in the above muscles. Each trigger point was subsequently massaged for better diffusion of the anesthetic. Patient tolerated the procedure well. There were no complications.
Outcome: Successful ultrasound guided injection of the temporomandibular joint and trigger point injections. The needle placement was confirmed.