ED Coding and Reimbursement Alert

Question: A 37-year-old librarian reports to the ED reporting pain at the base of her right radial wrist. She says about four days ago when she was stacking books, it started to ache. She had been using Ibuprofen to control the pain, but she says that it became unbearable yesterday; she reports an 8 on a 10-point pain scale. The ED physician exam reveals tenderness over the wrist; the patient exhibits a positive Tinel sign and is positive for carpal tunnel syndrome. During a level-three E/M service, the physician attempts to treat the patient's pain with anti-inflammatories, to no avail. Using a 22-guage needle, the physician performs a single tendon injection at the origin of the extensor tendon. How should I code this scenario? Tennessee Subscriber Answer: On the claim, report the following: 20551 (Injection[s]; single tendon origin/insertion) for the injection 99283 (Emergency department visit for the evaluation and management [...]