Neurology & Pain Management Coding Alert

For 2004, CPT has slightly refined the language used in the descriptors for tendon sheath and trigger point injection codes 20550-20552, but the changes serve only to clarify past coding principles and do not reflect any change in CPT policy.
 
The descriptors for 2004 now specify (new language is in bold):
20550 - Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar "fascia")
20551 - ... single tendon origin/insertion
20552 - Injection(s); single or multiple trigger point(s), one or two muscle(s). The addition of "single" to 20550/20551 reinforces that the code describes a lone or multiple injections to one tendon sheath, ligament or tendon origin/insertion. For example, you would report three injections to a single tendon sheath using one unit of 20550. For a single injection to the right tendon sheath and a single injection to the left tendon sheath, you would report 20550-LT (Left side) and 20550-RT (Right side).
 
The language defining 20552 (and 20553, ... single or multiple trigger point[s], three or more muscles) is identical to that used in 2003, although CPT has given the code its own subcategory to further differentiate it from 20550/20551.
 
As in past years, you should report 20552/20553 only one time per session, regardless of the number of injections or muscles injected.
 
"The codes are written to allow each code to be billed only once per day," says Allison Waxler, practice management policy analyst at the American Academy of Physical Medicine and Rehabilitation. "One or more injections in one or two muscles should be coded with one unit of 20552. One or more injections in three or more muscles should be coded with one unit of 20553. Providers cannot bill multiple units of either code if multiple injections are given or if multiple muscles are injected."
 
For instance, if the surgeon administers three injections into the trapezius muscle, report one unit of 20552. If the surgeon performs three trigger point injections into the trapezius muscle, two injections into the supraspinal muscle and two injections into the paraspinal muscle, report one unit of 20553.