ED Coding and Reimbursement Alert

Question: A patient reports to the ED for treatment of severe back spasms. After a level-three E/M, the physician orders four trigger point injections (TPIs): two in the patient's multifidis, and one each in the longissimus and psoas major. How should I code for this encounter? Montana Subscriber Answer: You should first check that the patient's insurer covers TPIs for muscle spasms, as acceptable ICD-9s for this service. Covered diagnoses depend entirely on the payer. Provided the payer accepts the diagnosis, report the following: • 20553 (Injection[s]; single or multiple trigger point[s], 3 or more muscle[s]) for all four TPIs • 99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity ...) for the E/M • modifier 25 (Significant, separately identifiable evaluation and management service [...]