Anesthesia Coding Alert

CPT 2002 revised 20550, which should no longer be used to report trigger-point injections. Instead, CPT 2002 introduced the following two new trigger-point codes, as well as two other related codes for tendon origin/insertion and carpal tunnel injections:
  20526 injection, therapeutic (e.g., local anesthetic, corticosteroid), carpal tunnel. This should be used only if the patient has a diagnosis of 354.0 (carpal tunnel syndrome, median nerve entrapment; partial thenar atrophy)

  20551 injection, tendon origin/insertion. This code is for injections in a specific area where the tendon originates and inserts into the bone.

  20552 injection, single or multiple trigger point(s);   one or two muscle group(s)

20553 three or more muscle groups.
Note: The procedures described by 20526 and 20551 were previously reported using the old trigger-point injection code (20550).
 
20550 has a new descriptor: injection; tendon sheath, ligament, ganglion cyst. The change means it applies only to superficial injections into the soft tissue. The new codes simplify coding, but may lessen reimbursement, says Kathleen Mueller, RN, CPC, CCS-P, a coding and reimbursement consultant in Lenzburg, Ill. Until now, trigger-point injections in different muscle groups could be billed separately using modifier -59 (distinct procedural service).
 
Some carriers paid for as many as eight injections per session. As of Jan. 1, 2002, however, even if eight injections are performed, only 20553 may be billed, because it includes "three or more muscle groups," Mueller notes.
 
Until CMS releases the fee schedule, the number of relative value units (RVUs) assigned to 20552 and 20553 is unknown. Although it is likely that these procedures may reimburse at a higher rate than a single 20550 claim used to, Mueller doubts 20553 could match multiple (up to eight) 20550 claims.
 
On the positive side, she says that reimbursement, though reduced, will probably be easier to obtain because the new codes are more specific. The new codes go into effect Jan. 1, 2002. Carriers have three months, until March 31, 2002, to implement them.