Anesthesia Coding Alert

An article in the December issue of Pain Management Coding Alert described the revisions to coding for trigger-point injections (TPIs). At that time, the relative value unit (RVU) of the two new codes, 20552 (Injection; single or multiple trigger point[s], one or two muscle group[s]) and 20553 ( single or multiple trigger point[s], three or more muscle groups), was unknown. CMS has now established interim RVUs for these codes.
 
As published in the Federal Register, Vol. 66, No. 212, the RVUs are as follows in the above chart:


There are no global periods attached to these codes.
 
Mary Jo Marcely, CPC, senior vice president of NAPA Management Service Corp., a firm in Syracuse, N.Y., specializing in anesthesiology and pain management consulting and billing, says, "It is evident from these changes that CMS has been evaluating these procedures from the standpoint of cost-effectiveness. Clearly, these changes will reduce reimbursement to practitioners. The final RVU will unlikely meet or exceed that which was previously used for TPIs, when some carriers allowed billing for up to eight injections per visit."
 
The AMA's relative value committee met at the end of January 2002 to establish final RVUs for these procedures.
Using the New Trigger-Point Injection Codes
Codes 20552 and 20553 are for single and multiple TPIs based on muscle group(s). Marcely notes, "This should eliminate the need to use modifier -51 (Multiple procedures) or modifier -59 (Distinct procedural service) that some local Medicare carriers previously required for multiple TPIs."
 
Marcely advises coders to be aware of the sites in the ICD-9 table of diagnoses. "When one of the defined sites is injected, it will be considered one injection service regardless of the number of injections administered."
 
"Not all carriers define muscle groups in the same manner," says Cindy C. Parman, CPC, CPC-H, co-founder of Coding Strategies in Denver, Ga., a healthcare consultancy that provides national support for anesthesia and pain management practices. "Instead of using an ICD-9 Codes table that corresponds to certain muscles for the purpose of TPIs, some carriers define specific sites." Parman cites the policy of HGSAdministrators, Pennsylvania's Medicare Part B carrier. For TPIs, the carrier recognizes eight body regions and defines eight sites:

 1. head
 2. cervical spine
 3. left upper extremities, including shoulder
 4. right upper extremities, including shoulder
 5. thoracic spine
 6. lumbosacral spine
 7. left lower extremities
 8. right lower extremities, including hip.
Carriers are also inconsistent in the reimbursement for bilateral muscle groups, such as the trapezius, deltoid [...]