Anesthesia Coding Alert

Trigger point injections (TPIs) have become common procedures for anesthesia specialists, especially with the growth of pain management care in the last few years. With the new TPI codes included in CPT this year, coders and practitioners should pay more attention to the procedure performed to code it correctly. Expanding TPI Reporting The addition of new codes and the revision of existing ones means that TPIs can be coded more accurately to reflect the services and describe multiple TPIs better. Most carriers recognize eight body regions and sites for TPIs: the head, cervical spine, left upper extremities including shoulder, right upper extremities including shoulder, thoracic spine, lumbosacral spine, left lower extremities including hip, and right lower extremities including hip. The primary code for TPIs is 20550* (Injection; tendon sheath, ligament, ganglion cyst), although the subcodes associated with it are now used to report TPIs. The descriptor for 20550* used to include "trigger points," but this part of the definition was deleted when the new TPI codes were added to CPT Codes 2002.

Another change in 2002 is the notation that other codes may be used with 20550* if imaging guidance is performed. These codes are 76003 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]), 76393 (Magnetic resonance guidance for needle placement [e.g., for biopsy, needle aspiration, injection, or placement of localization device] radiological supervision and interpretation) and 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation). But anesthesia providers such as Scott Groudine, MD, of Albany, N.Y., do not expect these codes to come into play often with TPIs because TPIs are given to spasmodic muscles, which do not show up on x-rays associated with these codes. Three new subcodes are connected to 20550*, two of which deal exclusively with TPIs: CPT 20551 Injection; tendon origin/insertion CPT 20552 single or multiple trigger point(s), one or two muscle group(s) CPT 20553 single or multiple trigger point(s), three or more muscle groups. When using the new codes, remember that 20551 is for a tendon injection and is not the same as a TPI into muscle. Code 20552 is used to report any number of TPIs to a single muscle group, such as five injections in the neck area, or single injections in two muscle groups, such as one TPI in the left upper extremity and one in the thoracic area. Code 20553 is used for any number of injections to three or more muscle groups, such as one injection to the head, two to the neck and one to the right lower extremity. TPIs are often performed at the same session as other services. In addition to the appropriate TPI code, you [...]