Rely on Areola Tissue Definition for Correct Procedure Code
Question: How is an injection to the areola coded? My provider wants me to use 20552, but I am thinking 96372. Rhode Island Subscriber Answer: First let’s look at the descriptors for each of these codes from the CPT® manual: 20552 (Injection(s); single or multiple trigger point(s), 1 or 2 muscles) 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular) Trigger points are located in a band of skeletal muscle. They can produce local or referred pain and can accompany other chronic musculoskeletal disorders. Since the breast, and specifically the areola, is not a muscle, code 20552 would not be appropriate. In this scenario, code 96372 is a better fit. This code describes a simple therapeutic or diagnostic injection, such as a local anesthetic injection, performed at a physician’s office under the skin at the areola. If an injection is for a mammary ductogram or galactogram, the appropriate code would instead be 19030 (Injection procedure only for mammary ductogram or galactogram). Currently there is no CPT® code that specifically describes an areola injection. Correct code selection depends on a careful and detailed review of the record. Julie McDaniel, MHA, CPC, CANPC, Contributing Writer
