Wiki Lidocaine Used Alone in Neck Injection for Muscle Spasms

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SymphonySamantha88

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Hi! I was told never to bill for lidocaine if included for comfort for another procedure. However, the patient had muscle spasms in the neck and lidocaine was the only drug injected for relief of her neck pain. What procedure codes would you use? And does the insurance usually ask for an invoice of what was paid for the lidocaine?

Clinical Example:
I did clean the area with ETOH swab and injected 1/2 cc of lidocaine wth epi into the occiptal muscles bilaterally close to the base of the skull 4 on right and 4 on left along the paraspinous muscles . I used a 30 Guage and inserted on 1/4" into the muscles. Patient had immediate relief at some locations. Total of 3.5 cc used.
 
Tpi

This would be a trigger point injection, and you would code 20552 or 20553. You cannot bill for the lidocaine separately, it is bundled with the injection code.
 
I believe the previous response to your question is incorrect. First of all, this is not a trigger point injection - this would be better reported this with CPT code 64616 - chemodenervation of muscles of the neck. Second, the lidocaine is not bundled if it is used as a therapeutic agent and you can report it. Insurance will not usually ask for an invoice because it's a low-cost and commonly used drug and they should have pricing available. Most payers will require you to report the NDC number and dosage on the claim though. You're correct that you would not normally report it if it's used as an anesthetic for a procedure as it's a supply that's normally included as part of the procedure.
 
thomas7331 said:
I believe the previous response to your question is incorrect. First of all, this is not a trigger point injection - this would be better reported this with CPT code 64616 - chemodenervation of muscles of the neck. Second, the lidocaine is not bundled if it is used as a therapeutic agent and you can report it. Insurance will not usually ask for an invoice because it's a low-cost and commonly used drug and they should have pricing available. Most payers will require you to report the NDC number and dosage on the claim though. You're correct that you would not normally report it if it's used as an anesthetic for a procedure as it's a supply that's normally included as part of the procedure.
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I don't agree with 64616, as lidocaine is not a neurolytic agent.
I believe the doctor may have intended this to be a trigger point, but if so, he needs to document that specifically.
 
Last edited:
Thanks Megan, I think you're correct the drug is not the right one for 64616, I answered without thinking it completely through. But to the original question, I still think the drug is reportable even if it's a trigger point injection, I've never heard that this would be bundled to the procedure in this situation.
 
thomas7331 said:
Thanks Megan, I think you're correct the drug is not the right one for 64616, I answered without thinking it completely through. But to the original question, I still think the drug is reportable even if it's a trigger point injection, I've never heard that this would be bundled to the procedure in this situation.
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I do agree with that aspect of the question--Lidocaine is separately reportable since it is the therapeutic agent used for this procedure. Thanks for the clarification!
 
Reporting the lidocaine

Wow! I don't have my certification yet, testing in August, but the practice management group my employer uses told us we couldn't bill for the lidocaine separately. I have already found so many inconsistencies with what they have said, and yet I still blindly believed this one. So, to clarify, we can bill the lidocaine and the trigger point injection?
 
You can bill the lidocaine if it is used as the therapeutic substance, however there is no reportable J code for lidocaine other than IV. This puts you using the J code for unspecified drug.
 
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