Anesthesia Coding Alert

Payers allow additional reimbursement when you report multiple units of 20550-20551 Anesthesia coders whose heads are still spinning from the myriad changes that CPT made to the trigger point injection (TPI) codes can finally relax. After two years of tinkering with the TPI codes, CPT Codes 2004 has moved on, and this time tendon and ligament codes got a facelift. Collect the approximately $60 that Medicare allots for 20550-20551 every time by following our expert coding tips.

CPT altered the ligament and tendon injection code descriptors this year:
  20550 -- Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar "fascia")
20551 -- ... single tendon origin/insertion. This year, CPT added "aponeurosis" to 20550's descriptor to make it more specific. In addition, the codes now distinguish between injections to the tendon itself rather than  the tendon sheath. You can also report the codes multiple times when appropriate to collect additional reimbursement. Report 20550 Multiple Times for Additional Injections Old way: Many anesthesiology coders remember when 20550 represented trigger point injections, says Scott Groudine, MD, an Albany, N.Y., anesthesiologist.

New way: CPT 2002 introduced new TPI codes (20552-20553), leaving 20550 to represent tendon sheath and ligament injections.

Anesthesiologists occasionally perform multiple tendon or tendon sheath injections during one session, but it doesn't happen frequently, says Mark Hines, MD, a pain management specialist in North Carolina. "I sometimes administer double injections, but don't go crazy with it."

Strategy: When the physician administers multiple injections, append either modifier -51 (Multiple procedures) or modifier -59 (Distinct procedural service) to the injection code. Hines says either of these modifiers is appropriate, but he is more comfortable with modifier -59 and generally doesn't face reimbursement problems.

Don't miss: Remember, the physician must inject separate sites before you can report multiple injections. Check your local carrier's policy for applicable guidelines.

CIGNA Medicare in Tennessee, for example, says, "Codes 20550 and 20551 should be reported one time for multiple or single injections to a tendon sheath, ligament, tendon origin or tendon insertion performed. Thus, multiple injections to the same tendon sheaths, tendon origins, tendon insertion, or ligaments would be reported one time only, while injections to multiple tendon sheaths, tendon origins, tendon insertion, or ligaments are reported one time for each injection."

Physicians treat plantar fasciitis more often than ever before, which might help explain why CPT changed 20550 to include the example of "aponeurosis (e.g., plantar 'fascia')."

Result: "This detail is important if you were unsure which code to use in the past," Hines says. "This simplifies [...]