Anesthesia Coding Alert

The CPT Codes 2004 books are hot off the press, and we've got the scoop on the code changes that will affect your practice. Popular Injection Codes Get Revised ... Again CPT 2003 revised many injection codes, and CPT 2004 updates some of them yet again. Revised injection and destruction codes of interest include (revised text in descriptors is underlined):

20550* - Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar "fascia")
20551 - Injection(s); single tendon origin/insertion 
20552 - Injection(s); single or multiple trigger point(s), one or two muscle(s). "Aponeurosis" is a sheetlike fibrous membrane that resembles a flattened tendon and binds muscles together or connects muscle to bone. Many coders had problems determining whether to use 20550 or 20551 for procedures, so revising the codes helps clarify their use.
 
"I believe some coders were confusing 20551 with aponeurosis since it deals with the means of origin or insertion of a muscle," says Debbie Gulledge, CPC, a coder with Anesthesia Associates of Rock Hill in Charlotte, N.C. Now CPT clearly spells out that you code aponeurosis with 20550.
 
Pain physicians often administer multiple injections to a single muscle or tendon to achieve better results. The old descriptor possibly indicated that the provider could only bill 20551 one time per session, even if he administered multiple injections. The descriptor change suggests that you can bill multiple units of 20551 if the physician injects separate tendon origins or insertions.
 
For example, a patient falls from a ladder and lands on his left ankle, which gives way beneath him. The patient then falls onto his side and hits his left shoulder. His physician might perform a tendon origin/insertion injection to the left Achilles tendon insertion, and a separate and distinct injection into the patient's left biceps tendon insertion. Simply adding the word "single" to 20551's descriptor means the physician in this scenario can bill both services and remain compliant. If you see this type of scenario, append modifier -59 (Distinct procedural service) to the second injection to indicate that the physician performed two different services.
 
The revised descriptors for 20552 and 20553 (... single or multiple trigger point[s], three or more muscles) were big news in CPT 2003 and changed how you reported some services; this year's change simply makes 20552 and 20553 non-indented codes. "People hopefully understand how to correctly report trigger point injections by now," Gulledge says. "If your providers routinely perform trigger point injections and you have current coding resources available, you shouldn't be as confused about reporting TPIs. You just need to pay close attention to the number of muscle groups involved."
 
CPT 2004 also amends the definition of 64680 (Destruction by neurolytic agent, with or without radiologic monitoring; celiac plexus). [...]