Trigger Point Injection Coding: Count Targets, Not Shots
Posted on 02. Apr, 2009 by Editor in Hot Coding Topics
Become the top TPI gun in your coding department with this FAQ.
Coders who are just itching to hit the mark on their trigger point injection (TPI) claims can answer the “who, what, and why” of TPIs with this guide.
1. Who Needs TPIs?
Most patients that require TPIs are suffering from head or muscle pain.
“Trigger points might be described as knots of muscle that form when muscles do not relax. Headaches are another reason that physicians perform TPI,” explains Joanne Mehmert, CPC, CCS-P, owner of Joanne Mehmert & Associates in Kansas City.
ON-DEMAND: Are you an OIG target? Pain management compliance training you can’t afford to miss.
When your physician performs TPIs, “the most common diagnosis reported is 729.1 (Myalgia and myositis, unspecified),” according to Judith Blaszczyk RN, CPC, ACS-PM, president of Veritas Consulting in Greencastle, Pa.
Keywords: Physicians might also use these synonyms for myalgia/myositis: “myfascitis, myofascial pain, fibromyalgia.” Code any of these diagnoses with 729.1, Mehmert recommends.
Other diagnoses that might accompany a TPI claim include muscle spasm (728.85) or contracture of neck or torticollis (723.5).
“Frequently physicians will document only the location of the pain — neck pain, low back pain, or headache — but in the case of trigger point injections they should really indicate more specifically the etiology of the pain,” Blaszczyk says. For instance, it would help to distinguish if the pain is from muscular spasm rather than an old fracture.
Many payers have limited payment policies for trigger point injections — and the physician can perform TPI on any of the 600-plus muscles in the human body, Mehmert says. So it is important that you check with each payer to see what it considers medically necessary for...
If you've already signed in and are still seeing this screen, click here to refresh the page.
- Free updates on CPT, ICD-9, HCPCS, Medicare, NCCI edits, and ICD-10.
- Discounts on 3rd party offers
Loading ...
nancy
14. Apr, 2009
how do i bill two trigger point injections 20552
Coding News
16. Apr, 2009
Hi, Nancy: Are you asking if you should use 20552 for two shots? If so, yes. Here is the reference from the article:
“If he injects two or fewer muscles, report 20552 (Injection[s]; single or multiple trigger point[s], 1 or 2 muscle[s]). If he performs TPI on three-plus muscles, report 20553 (… single or multiple trigger points, 3 or more muscle[s]), Blaszczyk confirms.”
The way I read it, even if the two shots are in the same muscle, use 20552 because the descriptor says “1 or 2 muscles.”
Hope this helps, Erin Lang Masercola, PhD, CPC
Cindy
23. May, 2009
Are there any circumstances in which you would use modifer 51 or 59 for 20550-20553?