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How to code Trigger Point Injections?

 

Trigger Point InjectionTrigger point injections are injections of a tendon sheath, ligament, trigger point(s) or ganglion cyst which consists of an anesthetic agent and/or therapeutic agent injected into the area to relax the intense muscles.

In case of TPI's, one must really indicate more specifically the etiology of the pain. Since Medical Necessity is the main criteria for TPI's, it is always advisable to keep your documention in a certain way:

  • Documentation of any evaluation/process of arriving at the diagnosis of the trigger point for an individual muscle or muscles should be clearly documentated in the patient's chart.
  • History of pain, location and intensity of pain should be noted.
  • Palpable knots of muscle or taut muscle bands should be recorded
  • Range of motion restriction, production of referred pain and/or any motor dysfunction should be duly noted in patient's chart.

Once the medical necessity is established, use the appropriate ICD-9 code as your diagnosis. Always keep a record of the muscles you are injecting. Since TPI's are per session codes and not per injection codes, no modifiers can be used. Select the appropriate code by the no. of muscles injected. For example: If a patient presents with pain in abdominal area and physician injects 6 injections on patient's Transverse Abdominus and 4 injections on patients Rectus Abdominus, you would report CPT 20552 [Injection(s);single or multiple trigger point(s), 1 or 2 muscle(s)]. Also report the appropriate J code from the HCPCS if any therapeutic drug is used.

When repeat Trigger Point Injections are necessary, the medical record must reflect the reason for repeated injections. Patient's response to the previous injection is an important factor in deciding any subsequent treatments. Evidence of any improvment to the range of motion in any muscle area after an injection would justify a repeat injection.

When services are performed in excess of establised parameters, they may be subject to a review for medical necessity. 

Posted by SMBS Team

Comments

We're debating whether or not we can bill units (muscle groups) with codes 20552 and 20553. Help!
Posted @ Monday, August 23, 2010 3:47 PM by Cate
Hi Cate, 
One should not bill units with cpt 20552 or 20553 as CPT 20552 itself says [Injection(s);single or multiple trigger point(s), 1 or 2 muscle(s)]and CPT 20553 says [Injection(s);single or multiple trigger point(s), 3 or more muscle(s)]
Posted @ Wednesday, August 25, 2010 9:39 PM by SMBS Team
I billed for 20552 (multiple TPI's in two muscle groups) with a diagnosis of myofascial pain syndrome with trigger points (729.1) but Medicare denied payment "based on medical necessity". Why? What else can I do to get reimbursed for the procedure? Thanks.
Posted @ Monday, January 03, 2011 11:32 PM by Jojo Castillo
We billed 20552 rt with 20610 76 rt to medicare. We were denied pymt for 20552 rt stating that it is not covered during the same session as other service. Is there another code we can use to get paid. Thanks.
Posted @ Thursday, January 13, 2011 9:04 AM by Joy Kronseder
When we bill 20552 rt and 20552 59 lt we are denied pymt for one of the codes by the insurance companies. Can someone help and tell me what we are doing wrong. I am taking over claims that are being denied and would like to fix the problem. Thanks.
Posted @ Thursday, January 13, 2011 9:06 AM by Joy Kronseder
I injected a fatty tumor with kenolog to try to atrophy it instead of excising it. How do I code for that?? It's not really a trigger point injection of a muscle. If was a painful lump and the patient did improve afterwards.
Posted @ Saturday, February 26, 2011 12:58 PM by T. Dupuis
Can we bill 20553 for 3 fingers, individually using 20553-F7, 20553-59,F8, 20553-59,F9; the documentation supports stating TPI given on 3 fingers; is this allowed?
Posted @ Friday, July 08, 2011 2:32 AM by Madhumitha
Hi Madhumita, 
 
By definition CPT 20553 describes [Injection(s);single or multiple trigger point(s), 3 or more muscle(s)]So no you cannot bill 20553 for 3 fingers, individually using 20553-F7, 20553-59,F8, 20553-59,F9. You can bill CPT 20553 only once per session irrespective of how many injections a physician has given to the patient if the muscles are 3 or more.
Posted @ Friday, July 08, 2011 7:11 AM by SMBS Team
Could you please help me? I billed 20552 with J2001 but FIDELIS denied 20552 as need to resubmit with appropriate ASA procedure code. Do you know what codes they are talking about?
Posted @ Wednesday, October 26, 2011 2:16 PM by HelenK
Hi Helen, 
 
You should not be billing J2001 with CPT 20552. J2001 is for IV infusions and not for injections. Since J2001 is lidocaine injection which doctors give to patients to reduce the pain , it is not reported separately. Hope this answers your questions.
Posted @ Thursday, October 27, 2011 9:15 AM by Nidhi
What dx can i use for a 20552, tried 719.41, 723.1 Medicare will not pay for these dx
Posted @ Tuesday, January 03, 2012 8:22 AM by Bonnie
Hi Bonnie, 
 
I'm not sure which is your Medicare contractor but based on highmark medicare services if you look for LCD 27540, it will tell you that dx 723.1 is a covered dx for trigger point injection. You can look for the LCD on medicare's website and on that basis file an appeal and attach the LCD print out. Hope this helps.
Posted @ Tuesday, January 03, 2012 10:53 AM by Symbiosis Team
I billed for 20552 (multiple TPI's in two muscle groups) with a diagnosis of myofascial pain syndrome with trigger points (729.1) but Medicare denied payment "based on medical necessity". Why? What else can I do to get reimbursed for the procedure? Thanks.
Posted @ Tuesday, April 23, 2013 11:26 AM by ANNETTE CHROSTOWSKI
OUR CODER BILLED AN OFFICE VISIT 99214 W/ MODIFIER 25. 20552; 96372; & J3301. DX CODE FOR THE INJECTION IS 719.41. MEDICARE DENIED NOT MEDICALLY NECESSARY. I AM NOT A CODER, I JUST CLEAN UP THE CLAIMS IN FOLLOW UP. CAN SOMEONE PLEASE HELP ME? 
 
THANKS.
Posted @ Monday, June 03, 2013 3:28 PM by MMG
Hi, 
Medicare has an LCD on Trigger Point Injections; since you did not mention the state please visit http://www.cms.gov/mcd/viewlcd.asp?l...on=32&show=all and view the LCD related to trigger point injections. This icd-9 ( 719.41) is not supported by CMS. You will need to discuss this with your coder or physician to see if there is any other appropriate diagnosis code for this condition. If there is, then you will need to submit an appeal along with a corrective claim and medical documentation attached. Hope this helps.
Posted @ Monday, June 03, 2013 3:46 PM by Nidhi Maheshwari
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