Neurology & Pain Management Coding Alert

Limit your claims to one unit of either 20552 or 20553 per patient encounter You'll report trigger point injections (20552-20553) with confidence if you know what muscle group(s) the neurologist treated, maintain solid documentation and avoid using modifier -59. Our experts offer three tips for improving your trigger point coding: 1. Count Muscle Groups,Not Injections To select between 20552 (Injection[s]; single or multiple trigger point[s], one or two muscle[s]) and 20553 (... single or multiple trigger point[s], three or more muscles) you must count the number of different muscles the physician treats. If the neurologist treats one or two muscles, report 20552. If the neurologist injects three or more separate muscles, report 20553. And, you should never report more than a single unit of either 20552 or 20553 per patient encounter, regardless of the number of injections the neurologists administers, says Allison Waxler, practice management policy analyst at the American Academy of Physical Medicine and Rehabilitation.

Follow CPT instructions: The descriptor for 20552 specifies "single or multiple trigger points." Therefore, billing 20552 lets the insurer know that your physician may have performed more than one injection, but reimbursement will not change. For instance, patients typically have back pain (724.x) that originates in one muscle group. Even so, they feel discomfort throughout their back and in other parts of the body, such as the legs and neck. But if your physician treats the pain with multiple trigger point injections and focuses on just one muscle, you must select 20552, regardless of the total number of injections the neurologist administers. Coding Example A: A patient who has lower back pain also complains that her arms and legs ache. During the examination, your physician discovers three trigger points in the multifidus muscle to the left of the L5 spinous process. The physician injects each trigger point in the multifidus muscle. You report 20552 because the physician treated only one muscle (multifidus), even though he administered three injections. Coding Example B: A patient recovering from an auto accident presents with neck pain (723.1, Cervicalgia) and shoulder pain (726.1x). The neurologist identifies three trigger points: the right trapezius, the left trapezius and the right sacroiliac muscles. In this case, you should submit 20553 because the physician injected three muscles. 2. Document Each Muscle Treated If your carrier rejects your 20552 or 20553 claim, check your documentation -- the medical record should clearly state which muscles the neurologist treated.

Most likely, insurers will reject claims based on documentation that ambiguously refers to muscles or focuses on the number of injections (which is irrelevant to selecting the proper code).

"Our biggest problem with the trigger points is getting our doctors to identify the injection sites so we [...]