Wiki Scar Injection CPT help!

[sarthur]

The doctor marked this injection as a trigger point but then indicated it was a scar injection. I've been trying to read other scar injection posts to determine how to code it (11900?, 64499?, 64455?, 64632?) but I'm still confused.


Patient was taken to the procedure room and scar was injected with a total of 10 cc of .25% bupivacaine, along with 40 mg of Depo-Medrol.

Pre & Post procedure DX: Scar entrapment neuropathy & myofascial pain syndrome.


Any help would be greatly appreciated!

 

[dwaldman]

The AMA has published coding guidance through CPT Assistant for injection of a scar neuroma or scar tissue, which are provided below.

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.
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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.

 

[sarthur]

Thank you so much for the response, Dwaldman!

Just to make sure I am understanding correctly, based on the the 2010 response "Injection of painful scar tissue is reported using CPT code 64999, Unlisted procedure, nervous system" the correct code choice used to be 64999. However, the 2013 article directs us to use the appropriate injection code instead of 64999 "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."Or am I oversimplifying the connection between scar tissue and neuroma?
For instance, would I just use a trigger point injection code instead of 64999 for the sample dictation in the original post?

 

[dwaldman]

The codes for trigger point injections such as 20552 would be a muscle injection. Although the diagnosis states: "Scar entrapment neuropathy & myofascial pain syndrome" and 729.1 is typical condition for a trigger point injection. If you have the ability to query the physician, you would need to explain that when the "scar" is being injected, you would need more information on what is actually being injected (ie, muscle, neuroma, or scar tissue)