Wiki Help Needed

[Melissa Harris CPC]

Can someone please tell me what to code? The doctor wrote on the encounter form interspinous ligament and scar injection x 3. Is it 20550 or 20553?
Thank you


DATE OF PROCEDURE: May 26, 2015
DX: SPRAIN
ANESTHESIA: Local

Medications used: 2 mL of .25% Marcaine, 1 ml of 40mg/mL Kenalog and 2mL of normal saline

DESCRIPTION OF PROCEDURE: With written informed consent obtained, risk and benefits were discussed including but not limited to infection, bone, nerve and joint damage, and paralysis.

The patient is then brought to the operating room and with appropriate monitors in place, the patient was placed prone on the procedure room table. An area at the scars,T11/T12, T5/T6 and T6/T7, is cleansed with Betadine using sterile technique, using a 25 gauge 1.5 inch needle, 1.75 mL of the above injectate is injected at each site.
The needle is removed, the area is cleansed and bandaids were placed.

The patient was removed from the procedure table in stable condition and brought to the recovery area having tolerated the procedure well.

 

[dwaldman]

There are two AMA CPT Assistant articles regarding injection of scar tissue (not in the muscle) and scar neuroma.

I don't see three separate muscles documented to support 20553. Nor does the note state what is being injected specifically. The diagnosis of "Sprain" is not going potentially be a covered diagnosis for trigger point injection under 20552. If this was strained ligament, I agree with 20550. This does not sound like a scar neuroma or scar tissue as the specific site of injection.

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September 2010 page 10

Surgery: Nervous System, 64999 (Q&A)

Question: The patient has postmastectomy pain in the scar tissue area and not in the muscle. An injection was performed into the scar tissue of the chest area using a mixture of triamcinolone topical, lidocaine with epinephrine, and bupivacaine hydrochloride with epinephrine. What CPT code should be reported for this procedure?

Answer: Injection of painful scar tissue is reported using CPT code 64999, Unlisted procedure, nervous system. When reporting an unlisted code to describe a procedure or service, it is necessary to submit supporting documentation (eg, procedure report) along with the claim to provide an adequate description of the nature, extent, and need for the procedure, and the time, effort, and equipment necessary to provide the service.
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November 2013 page 14

Frequently Asked Questions:Surgery: Nervous System

Question: Is code 11900, Injection, intralesional; up to and including 7 lesions, or the unlisted code 64999 the appropriate code to report for injections of neuromas?

Answer: Neither code is appropriate to report for injections of neuromas. A "neuroma" is a thickening of scar tissue on the nerve and/or lining of the nerve; therefore, the appropriate nerve injection code should be reported based on the nerve injected. For example, code 64455, Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, Morton's neuroma), and code 64632, Destruction by neurolytic agent; plantar common digital nerve, would be reported for a neuroma injection involving the plantar nerves in the foot.