Orthopedic Coding Alert

Here’s why ICD-10 smarts are key for these 3 injection services.

Do you sometimes feel like you don’t have a shot at rightful reimbursement when you file an injection services claim? If so, you should take a look at what two experts had to say about a trio of injection services that just about every coder will encounter in an ortho setting.

During a Virtual HEALTHCON 2020 session, Nate Felt, MS, ATC, PTA, CPC, of Intermountain Medical Group, took attendees through how to code for the following injections: tendon sheath/ligament; carpal tunnel (CT); and trigger point.

Check out a bit of what they got to learn during Felt’s session.

Tendon Sheath Shot Used for Hundreds of Conditions

One of the most common injection procedures you’re likely to see is the tendon sheath/ ligament shot, which is commonly used to treat conditions like trigger finger, tennis elbow, Achilles tendonisis, and distal bicep tendonitis, said Felt. You’ll report this service with 20550 (Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar “fascia”)).

Chalk up this injection’s frequency to its versatility; your provider can perform it on any tendon sheath in the body. A tendon sheath, Felt reminded, “is a layer of synovial membrane around a tendon. It permits the tendon to stretch and not adhere to the surrounding fascia.” So, any tendons in any anatomical area are potential 20550 targets.

One Local Coverage Determination (LCD) reports more than 500 ICD-10 codes that are approved for 20550, among them:

• M25.3XX (Other instability of joint)
• M75.2X (Bicipital tendinitis)
• M76.0X (Gluteal tendinitis)
• M76.3X (Iliotibial band syndrome)
• M76.6X (Achilles tendinitis)
• M76.7X (Peroneal tendinitis)
• M77.0X (Medial epicondylitis)
• M77.1X (Lateral epicondylitis)

Note: This is not a definitive list. Check your LCDs for to discover acceptable diagnoses for 20550.

Aim at Muscle Count on TPI Code Choice

One of the standard injection services is the trigger point injection (TPI). As with the tendon/sheath shot, your provider can use TPI to provide treatment in a multitude of anatomical areas, and for many different conditions.

The most common diagnoses for TPIs are muscle pain, myalgia, fibromyalgia, and myofascial pain syndrome. “Muscle spasm is also frequently reported,” explains Judith L Blaszczyk, RN, CPC, ACS-PM, ICDCT-CM, compliance auditor at ACE, Inc. in Overland Park, Kansas.

When you’re reporting TPIs, you’ll use the following codes, depending on encounter specifics:

• 20552 (Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s))
• 20553 (Injection(s); single or multiple trigger point(s), 3 or more muscles)

Count muscles, not shots: As you’ll see from the code descriptors, you’ll choose a TPI based on the number of muscles your provider injects — not the number of injections the provider performs on a muscle. For this reason, “it is very important that the physician document each muscle that is injected so the coder can select the correct code,” reminds Blaszczyk.

Since trigger points may occur in any skeletal muscle, almost any skeletal muscle may be injected. One LCD lists the following ICD-10 codes as acceptable diagnoses for TPIs:

• M54.2 (Cervicalgia)
• M54.5 (Low back pain)
• M54.6 (Pain in thoracic spine)
• M79.1 (Myalgia)
• M79.7 (Fibromyalgia)

Note: This is not a definitive list. Check your LCDs for which codes are acceptable diagnoses for TPIs.

CT Injection

One of the higher-paying — though rarer — injection services in your office is likely to perform is a carpal tunnel (CT) injection, according to Felt. You’ll report this service with 20526 (Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel).

You won’t see many 20526 claims because the shot is designed to treat a single condition: carpal tunnel syndrome (CTS). Thus, CTS diagnosis codes are probably the only ones you’ll be using to report 20526. Here’s the CTS ICD-10 codes that will prove medical necessity for 20526, depending on encounter specifics:

• G56.01 (Carpal tunnel syndrome, right upper limb)
• G56.02 (Carpal tunnel syndrome, left upper limb)
• G56.03 (Carpal tunnel syndrome, bilateral upper limbs)

Documentation Drives Successful Injection Claims

Felt reminded attendees that documentation for all injection claims should include answers to the following queries:

• What drug and dosage was injected?
• Where was it injected? (Be as specific as possible.)
• How did the patient respond to the injection?