Anesthesia Coding Alert

Question: Our pain management specialist administered an injection to treat costochondral joint syndrome; he inserted the needle at the junction of the first rib and sternum until he contacted bone, then he injected Marcaine and Kenalog. This is not a joint injection, so how should I code the procedure?

North Carolina Subscriber

Answer: Because your provider placed the needle in the costochondral joint, some coders believe your best choice is 20600 (Arthrocentesis, aspiration and/or injection; small joint or bursa [e.g., fingers, toes]). Other sources, however, lean toward 20605 (... intermediate joint or bursa [e.g., temporomandibular, acromioclavicular, wrist, elbow, or ankle, olecranon bursa]). The costochondral joint might be more similar in size to the joints represented by 20605, so ask your physician's advice on which is more accurate.

Avoidance: Don't use 20552 (Injection[s]; single or multiple trigger point[s], 1 or 2 muscles) or 20553 (... single or multiple trigger point[s], 3 or more  muscle[s]) for this procedure. Costochondral junction syndrome (also called Tietze's syndrome or costochondritis) is an inflammation of the cartilage and bones in the chest wall. Codes 20552 and 20553 aren't good choices for your situation because they describe muscle injections