Use This Guide to Tackle Your Tendon Injection Claims
Remember to prove medical necessity. Providing therapeutic injections to tendons or ligaments are services that orthopedists commonly perform, but some coders can still struggle reporting the procedures. Missing documentation, inaccurate diagnosis codes, and incorrect procedure codes are examples of common errors that result in claim denials. Keep reading to learn what tendon sheath injections include and how to correctly report the procedure. Understand What 20550 Includes CPT® code 20550 (Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar “fascia”)) represents an injection that an orthopedist administers to target an inflamed area to relieve pain and give better function. The provider injects a therapeutic agent, which could be a corticosteroid, anesthetic, or even a combination of both. The medication is injected into the tendon sheath or ligament. When giving this kind of injection, if the provider does more than one injection and it is in more than one anatomic site or tendon sheath, you might need to append a modifier, such as 59 (Distinct procedural service) or XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure), to show that the additional injections occurred at a different site or sheath. Pay Attention to 20550 Coding Guidelines You’ll need to pay attention to CPT® guidelines to ensure your 20550 reporting is accurate. For instance, 20550 represents only one injection site and cannot be reported per tendon. As mentioned above, remember to use modifier 59 or XS when the provider injects multiple sites. At the same time, you can’t report the following codes with 20550: Get to Know the Common Diagnosis Codes for 20550 The appropriate diagnosis code will have to be included in the documentation. ICD-10-CM code examples that could support medical necessity include: The documentation needs to ensure that you are reporting the most appropriate code to represent the specific anatomical site and include clinical indications by the provider. Remember Documentation Requirements Before you can assign procedure or diagnosis codes, you’ll review the orthopedist’s documentation for the encounter. The medical documentation is required to contain specific information for you to use 20550, such as: If ultrasound guidance was used and documented, then you would also need to report 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation) separately with appropriate medical documentation to support the code. Examine These Case Examples Case 1: A 57-year-old patient presents with pain and some swelling in the right wrist; this is consistent with de Quervain’s tenosynovitis. After evaluating and examining the patient, the provider suggests the injection of a corticosteroid, which would be medically necessary so the pain and inflammation would be reduced in the extensor tendon sheath. Under sterile techniques, the provider injects 1 mL of a corticosteroid and 0.5 mL of lidocaine into the tendon sheath of the abductor pollicis longus and extensor pollicis brevis tendons at the wrist. The patient tolerated the procedure well. Documentation must include: Case 2: A 30-year-old patient presents with pain in the heel that is chronic and they are diagnosed with plantar fasciitis of the left foot. The provider has tried conservative treatments, including rest, ice, and nonsteroidal anti-inflammatory drugs (NSAIDs), without any improvement. The orthopedist elects to perform a corticosteroid injection into the plantar fascia, which you should code as tendon sheath/aponeurosis injection. The physician discusses the procedure’s risks and benefits, and sterilizes the area of maximal tenderness on the left plantar surface. Using a 25-gauge needle, the provider injects a mixture of 1 mL of triamcinolone acetonide (40 mg/mL) and 1 mL of 1 percent lidocaine into the plantar fascia. The patient tolerates the procedure well, and post-procedure care instructions are given to the patient. Documentation must include: Bilateral injections: If the provider completed injections on both feet, you’ll report 20550 appended with modifier 50 (Bilateral procedure) to show the payer that the physician performed bilateral injections. Within the documentation it is going to be necessary to clearly identify that the provider treated both sides. Summary Documentation must properly support the use of 20550 along with the diagnosis code to support medical necessity of the injection, which would also ensure compliance with payer requirements. Code 20550 is only used when the documentation shows that an injection into a tendon sheath, ligament, or aponeurosis is completed. You cannot report the injection with 20550 if the physician injected medication into the joint or tendon origin/insertion. Becky Joiner, CPC, CPMA, Contributing Writer
