Wiki 20552 vs 20553

Community Wiki

This is a community-maintained wiki post containing the most important information from this thread. You may edit the Wiki once you have been on AAPC for 30 days and have made 5 posts. Learn More
D
Billing question
Can these CPT 20552 or 20553 code be billed at the same time with the acupuncture codes since service is performed the same date with the appropriate provider ( two different providers and authorization obtain)
Dina

coding4fun

Guru
Messages
141
Location
High View, WV
Best answers
0
I am sure that I am overthinking this and making it harder on myself. Our physician states in her note "Left and Right SI joint injection administered to lumbar". I realize that 20552 states 1 or 2 muscles and 20553 states 3 or more muscles. Since the physician stated Left & Right injection I coded this case using 20552-RT, 20552-RT-59. It was denied by carrier. Of course my only other selection left is 20553. I just want to make sure that I am understanding the usage of these two codes as I am thinking lumbar has two separate locations (Left & Right). Thank you in advance for any help with this matter.
 

mitchellde

True Blue
Messages
13,537
Location
Columbia, MO
Best answers
2
20552 AND 20553 are for muscle injections, you stated SI joint injections. therefore you would not use either of these codes , you will need a code for an SI joint injection.
However to answer the question of the 20552 and 20553, it is the number of muscles injected not locations, you can bill only either the 20552 with 1 unit or the 20553 with 1 unit.
 

mhstrauss

True Blue
Messages
1,240
Location
Baton Rouge
Best answers
0
20552 AND 20553 are for muscle injections, you stated SI joint injections. therefore you would not use either of these codes , you will need a code for an SI joint injection.
However to answer the question of the 20552 and 20553, it is the number of muscles injected not locations, you can bill only either the 20552 with 1 unit or the 20553 with 1 unit.

Per notation in CPT book under 27096, use 20552 if injection performed without CT or fluoro guidance.
 

coding4fun

Guru
Messages
141
Location
High View, WV
Best answers
0
When looking up SI joint injection (27096) it clearly states that if performed without CT guidance use 20552. We will not be using CT guidance. I do realize that 20552 is for trigger point injections and do not feel that is appropriate for this case. Would it be appropriate to use 20610? I do not feel like this would justify the service either. Am looking for good advice on what to use? This is a bilateral procedure so if 20552 is appropriate would I bill 20552-RT, 20552-LT-59. This is a non medicare insurance coverage.
 

mitchellde

True Blue
Messages
13,537
Location
Columbia, MO
Best answers
2
When looking up SI joint injection (27096) it clearly states that if performed without CT guidance use 20552. We will not be using CT guidance. I do realize that 20552 is for trigger point injections and do not feel that is appropriate for this case. Would it be appropriate to use 20610? I do not feel like this would justify the service either. Am looking for good advice on what to use? This is a bilateral procedure so if 20552 is appropriate would I bill 20552-RT, 20552-LT-59. This is a non medicare insurance coverage.

20552 is for 1 or 2 muscles, you cannot bill more than one 20552 per session.
 
Top