Wiki 20553 & 64450

[nlbarnes]

Hello - I have a difficult time with this procedure. I'm not sure if I just don't understand or if the documentation is lacking. I've queried the provider before but want to know this before going back to him. Thanks.

Procedure Note: Therapeutic Injection

Indication: primary and secondary myofascial pain and related regional paresthesias

Patient informed of risks, benefits and alternatives to treatment. Patient provides written and verbal consent for procedure.

Skin prep utilizing ChloraPrep cleanse to all treatment sites.

Injection provided with a 27 G 1/14" needle below the neck: 1/2" above the neck with the following mixture in 0.5-1 ml amounts with site coolant provided pre-injection.
Bupivacaine 0.25% 3 ml
Lidocaine 1% 1 ml
Normal Saline 6 ml

MUSCULOSKELETAL:
Areas of myospasm with referred pain and parasthesias are treated with injection in the following area with attempt to reduce myofascial tension and provide peripheral nerve desensitization in the underlying regions:
b/l cervical paraspinals, levator scapulae, upper trapezius, medial parascapular musculature, splenius capitis and rhomboids.

 

[nickelclaw]

if guidance is used fluoro or CT then category would be 64490-64495
per AMA CPT book
if no guidance or imaging not used then report injection of shealth/ligament 20550-20551 or trigger point injections 20552-20553

 

[mrahsan]

Would you like to tell the insurance name. Some insurance have a very tricky guidelines to evaluate. I hope it is not NHP.

 

[nickelclaw]

the above isn't from insurance it is in the coding book guidelines. I do facility coding not sure of insurance contracts/policies

 

[nlbarnes]

if guidance is used fluoro or CT then category would be 64490-64495
per AMA CPT book
if no guidance or imaging not used then report injection of shealth/ligament 20550-20551 or trigger point injections 20552-20553

Hi - isn't the documentation a little light or is it me?

 

[nickelclaw]

Hello,
I don't think so. It mentions the drug and amount the reason for injection and the muscles that were injected.

 

[nlbarnes]

Would you like to tell the insurance name. Some insurance have a very tricky guidelines to evaluate. I hope it is not NHP.

Hello - I'll have to find the patient now. But what I'm looking for is the documentation insufficient?

Hello,
I don't think so. It mentions the drug and amount the reason for injection and the muscles that were injected.

Thanks so much. Have a great weekend!

 

[fradyk]

Codes 20552 and 20553 are trigger point injections to muscles while 64450 is a peripheral nerve block injection. The question is, is the nerve being injected or the muscle? For trigger point injections, the provider will palpitate the muscles to locate the area of pain and inject the muscles. Nerve block is exactly what it says injections to the nerve or nerve branch.