I would look at the below Supercoder article, I think their advice on making sure the documentation supports the procedure describes it being performed at the tendon origin/insertion in order to even bill 20551. They also point out tennis elbow injection can be seen to be reported as 20550.
There is a difference in payment with Medicare total RVU of 1.71 of 20551 at a higher rate than 20550 at RVU of 1.67.
Additionally, AMA CPT Assistant 2003, describes that both CPT codes (20550, 20551) have the plural form of injections(s) in their code descriptors which would require the documentation to support: " multiple tendon sheaths, tendon origins, tendon insertion, or ligaments are reported one time for each injection"
The CMS MUE edit describes coverage for up to 5 units of 20550 or 20551. Possibly if the documentation supports multiple separate injections of tendon origins/insertions or sheaths on one side with an additional injection on the contralateral side, then potentially a total of the 3 units could be reported and ultimately the 2 and third unit would be paid at 50 percent, or the carrier might require modifier 50 with 2055X then an line 2055X with the 51 modifier. But if the documentation supports the 3 separate injections, I believe it would be reported with 3 units; at least this is the way I have been instructed for multiple joint injections that have been bilateral in addition to additional joint from carrier instructions from WPS Medicare J5.
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20551
Injection(s); single tendon origin/insertion
20550
Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia")
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Supercoder website Q & A
https://www.supercoder.com/coding-n...551-for-elbow-epicondylitis-injection-article
Question: What is the best code for an injection to treat elbow epicondylitis?
Missouri Subscriber
Answer: When your physician does this procedure, she generally is injecting the insertion, which is 20551 (Injection
; single tendon origin/insertion). However, CPT's section on elbow introduction or removal includes the notation, "for injection of tennis elbow, use CPT 20550" (Injection, single tendon sheath, or ligament, aponeurosis [e.g., plantar "fascia"]). Code 20551 might be the best choice in many cases, but check your physician's documentation to be sure you shouldn't be reporting 20550 or another code instead.
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AMA CPT Assistant September 2003 page 13
Coding Update:Tendon Sheath Injections
This article was referenced on page 9 of the October 2014 issue in the article Trigger Point Injections Using "Dry Needling" Technique.
In this article, we will focus on codes for injection(s) of a tendon sheath ligament (20550) and injection(s) of tendon origin/insertion (20551). Although the parent code (20550), indicates, "Injection(s)," codes 20550 and 20551 should be reported one time for multiple or single injections to a single tendon sheath, ligament, tendon origin, or tendon insertion performed. Thus, multiple injections to the same tendon sheaths, tendon origins, tendon insertion, or ligaments would be reported one time only, while injections to multiple tendon sheaths, tendon origins, tendon insertion, or ligaments are reported one time for each injection.