To make it clear that injections were done at different sites, submit 20550 for the first site injected and 20550 with modifier -59 (to show that a different site was injected) and modifier -51 (to indicate multiple procedures were performed) for subsequent injection sites.
What finger do you use to inject 20550?
Dr. injected the left index finger, middle finger and thumb for trigger finger. Would I bill 20550 with F1, F2 and FA modifiers or can I only bill 20550 once?
What is the CPT/HCPCS code for injections?
The submitted CPT/HCPCS code must describe the service performed. The medical record must clearly indicate the number of injections given per session and the site (s) injected. Furthermore, the medical record must clearly document the medical necessity for repeated injections of trigger point (s).
What is the CPT code for injection of multiple tendons?
It sounds as if your physician injected three tendons. 20550 says "injection (s) of a single tendon sheath...) the coding tips in the coding companion state that if more than one tendon is injected in the same incounter, each injection should be reported separately.
What is the CPT code for plantar fascia injection?
Injections to include both the plantar fascia and the area around a calcaneal spur are to be reported using a single 20551. The clinical record should include the elements leading to the diagnosis and treatment decision to use injection.
How do you code multiple joint injections?
Report a single unit of 20600-20611 for each joint treated, regardless of how many aspirations and/or injections occur in a single joint. You may report multiple units of a single code for aspiration/injection of multiple joints of same size (e.g., two large joints, left knee and left shoulder).
How do you bill multiple trigger finger injections?
CPT code 20550 is frequently used for a trigger finger injection, where the injection is administered to the tendon sheath.
What modifier should be used with 20550?
Medicare requires modifier 50 to be reported with eligible codes on a single claim line (e.g., 20550-50).
How do I bill bilateral injections to Medicare?
Bilateral surgical and nonsurgical procedures are reported as a single code billed (1) with modifier 50, (2) twice on the same day with RT and LT modifiers, or (3) with 2 units. For Medicare plans, Aetna pays 150% of the fee schedule amount for a bilateral surgical procedure.
How do you code a bilateral trigger point injection?
HOW TO BILL BILATERAL TRIGGER POINT INJECTION20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)20553 Injection(s); single or multiple trigger point(s), 3 or more muscles.
Can 20550 and 20552 be billed together?
You should report 20552 and 20553 only once per session, regardless of the number of injections or muscles involved. You should also report 20550 and 20551 only once per tendon sheath, ligament, or tendon origin/insertion, regardless of the number of injections involved.
How do I bill multiple 20550?
However, procedure code 20550 is subject to multiple surgery rules (Modifier 51). It is recommended that you bill all services at 100% of billing charge. Let the insurance carrier apply, the reduction in reimbursement.
Is 20550 a bilateral code?
Procedure code 20550 is not subject to bilateral surgery rules. Therefore these services should not be billed with procedure code modifier 50 (Bilateral Procedure). 2. However, procedure code 20550 is subject to multiple surgery rules (Modifier 51).
Is CPT code 20550 covered by Medicare?
General Guidelines for claims submitted to or Part A or Part B MAC: Claims for the injection of collagenase clostridium histolyticum should be submitted with CPT code 20550. CPT code 20550 should be reported once per cord injected regardless of how many injections per session.
When do you use modifier 50 vs LT RT?
Modifier LT or RT should be used to identify which of the paired organs was operated on. Billing procedures as two lines of service using the LT and RT modifiers is not the same as identifying the procedure with modifier 50. Modifier 50 is the coding practice of choice when reporting bilateral procedures.
What is the modifier for bilateral?
Modifier 50Modifier 50 applies to bilateral procedures performed on both sides of the body during the same operative session. When a procedure is identified by the terminology as bilateral or unilateral, the 50 modifier is not reported.
What is the 32 modifier used for?
When to use Modifier 32. Modifier -32 indicates a service that is required by a third-party entity, Worker's Compensation, or some other official body. Modifier 32 is no used to report a second opinion request by a patient, a family member or another physician. This modifier is used only when a service is mandated.
Why do you need injections for trigger points?
Besides injection into trigger points, local injections are useful in the treatment of pain or dysfunction due to inflammation or other pathological changes of tendon sheaths, and ligaments . Findings may include pain on motion or palpation, swelling, friction rubs and/or catches.
What is CPT code 20550?
For example, CPT code 20550 (“Injection (s); single tendon sheath, or ligament, aponeurosis (eg, plantar “fascia”)”) describes a therapeutic musculoskeletal injection. It is a misuse of this code to report it for the injection of local anesthesia in order to perform another procedure such as a hallux valgus correction (CPT code 28292). Therefore, CPT code 20550 is bundled into CPT code 28292.
What is 355.6 used for?
354.0 Carpal tunnel syndrome 355.5 Tarsal tunnel syndrome 355.6* Lesion of plantar nerve Note: Use 355.6 for Morton’s metatarsalgia, neuralgia, or neuroma 720.0-720.2 Ankylosing spondylopathies and other inflammatory spondylopathies 720.81 Inflammatory spondylopathies in diseases classified elsewhere 720.89 Other inflammatory spondylopathies 720.9 Unspecified inflammatory spondylopathy 723.7 Ossification of posterior longitudinal ligament in cervical region 724.71 Hypermobility of coccyx 724.79 Other disorders of coccyx 726.0 Adhesive capsulitis of shoulder 726.10-726.12 Rotator cuff syndrome of shoulder and allied disorders 726.19 Other specified disorders of bursae and tendons in shoulder region 726.2 Other affections of shoulder region not elsewhere classified 726.30-726.33 Enthesopathy of elbow region 726.39 Other enthesopathy of elbow region 726.4-726.5 Enthesopathy of wrist and carpus 726.60-726.65 Enthesopathy of knee 726.69 Other enthesopathy of knee 726.70-726.73 Enthesopathy of ankle and tarus 726.79 Other enthesopathy of ankle and tarsus 726.8 Other peripheral enthesopathies 726.90-726.91 Unspecified enthesopathy 727.00-727.06 Synovium and tenosynovitis 727.09 Other synovium and tenosynovitis 727.1 – 727.3 Other disorders of synovium, tendon and bursa 727.40-727.43 Ganglion and cyst of synovium, tendon and bursa 727.49 Other ganglion and cyst of synovium, tendon and bursa 727.50 -727.51 Rpture of synovium 727.59 Other rupture of synovium 727.60-727.69 Rupture of tendon, nontraumatic 727.81-727.83 Other disorders of synovium, tendon and bursa 727.89 Other disorders of synovium tendon and bursa 727.9 Unspecified disorder of synovium tendon and bursa 728.4-728.6 Disorders of muscle, ligament and fascia 728.71 Plantar fascial fibromatosis 728.79 Other fibromatoses of muscle ligament and fascia 729.0-729.1 Other disorders of soft tissues 729.4 Fasciitis unspecified 733.6 Tietze’s disease 840.0-840.9 Sprains and strains of shoulder and upper arm 841.0-841.3 Sprains and strains of elbow and forearm 841.8-841.9 Sprains and strains of elbow and forearm 842.00-842.02 Sprains and strains of wrist 842.09 Other wrist sprain 842.10-842.13 Sprains and strains of hand 842.19 Other hand sprain 843.0-843.1 Sprains and strains of hip and thigh 843.8-843.9 Sprains and strains of hip and thigh 844.0-844.3 Sprains and strains of knee and leg 844.8-844.9 Sprains and strains of knee and leg 845.00-845.03 Sprains and strains of ankle 845.09 Other sprains and strains of ankle 845.10 – 845.13 Sprains and strains of foot 845.19 Other foot sprain 846.0-846.3 Sprains and strains of sacroiliac region 846.8-846.9 Sprains and strains of sacroiliac region 847.0-847.4 Sprains and strains of other and unspecified parts of back 847.9 Sprain of unspecified site of back 848.0-848.3 Other and ill-defined sprains and strains 848.40-848.42 Other and ill-defined sprains and strains of sternum 848.49 Other sprain of sternum 848.5 Pelvic sprain 848.8-848.9 Other and ill-defined sprains and strains
Is a trigger point injection considered a reasonable treatment?
The injection of trigger point (s) will be considered to be medically reasonable and necessary for the treatment of trigger points that are unresponsive to non-invasive treatments or when non-invasive methods of treatment are contraindicated.
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General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
This First Coast Billing and Coding Article for Local Coverage Determination (LCD) L33912 Injection of Trigger Points provides billing and coding guidance for diagnosis limitations that support diagnosis to procedure code automated denials.
ICD-10-CM Codes that Support Medical Necessity
The following ICD-10-CM codes support medical necessity and provide limited coverage for CPT codes: 20552 and 20553.
ICD-10-CM Codes that DO NOT Support Medical Necessity
All those not listed under the “ICD-10-CM Codes that Support Medical Necessity” section of this article.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.