ED Coding and Reimbursement Alert

Question: A patient reports to the ED complaining of severe neck pain. He reports that two days ago he sustained an injury when he picked up a lawn mower to move it in his back yard. In  addition to the neck pain, he also reports some numbness and tingling in his right arm. The patient says the pain has been constant since the injury and over-the-counter medications have not helped. The physician performs a history and physical exam and expresses concern that the patient may have a herniated cervical disc in addition to muscle strain. He orders an MRI of the cervical spine and prescription pain killers. In his exam, he also found several trigger points in the trapezius and scalene muscles. He injects the trigger points to give the patient more immediate relief. Final diagnosis is "torticollis NOS." In this situation, are the injections separately reportable, or is the trigger point injection (TPI) part of the E/M service?

Michigan Subscriber

Answer: When the ED physician performs TPIs, you can report them with procedure codes; unlike therapeutic injections and infusions, you can code for ED TPIs. On the claim, report the following:

• 20552 (Injection[s], single or multiple trigger point[s], 1 or 2 muscle[s]) for the TPI
• The appropriate level ED E/M code (99281-99285,  Emergency department visit for the evaluation andmanagement of a patient, which requires these 3 key components ...) depending on encounter notes
• Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to the E/M to show that the E/M and the TPIs were separate services
• 723.5 (Other disorders of cervical region; torticollis, unspecified) appended to 20552 and the E/M code to represent the patient's injury.