Wiki Billing Facet Injections with Trigger Point (Same Date of Service)

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turnkeymd

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I've inherited a stack of denials to work for procedures performed by a Pain Management doctor. They are mostly facet injections AND trigger point performed on the same date of service with the following scenario:

64490
64491
64492
20610
J3001
76942

I realize that modifiers are missing here. What I'm wondering is if the doctor should perform the trigger point injections on the same date as the facet, or perform those on a different date. Has anyone had issues with these? Assuming the trigger point injections are for a different site and diagnosis, I would append with modifier 59. But if he shouldn't ever perform these together, then I need to let him know.

Thanks for the help!
 
I don't see why you can't. There are no guidelines that indicate only one should be done at a time.

A lot of providers would rather the patient get it all done the same day than have them come back.

As long as the documentation indicates a different location, I would bill for both. :)
 
I agree, if the trigger point injection is at a different site (which I imagine it always would be if it is truly a trigger point injection) then the modifier 59 or XS would be appropriate.

It would never be up a coder to tell a provider what procedures they should or should not perform together on the same date - that is a clinical and medical practice decision, not a coding one. The bundling edits are in place only to prevent providers from reporting an incidental injection at a given site for which payment is already included in the code for the base procedure. Bundling edits are for purposes of ensuring correct reporting and reimbursement only - they are not meant to restrict what provider may or may not do in the way of patient treatment.
 
Thank you for the responses. I just realized that I included 20610 in my original post but meant to include 20552, which is a trigger point injection.
 
I looked into NCCI and I noticed you are billing facets which include fluoroscopy and US guidance. NCCI states that you can only bill for 1 not both- this may be reason for denials. Since your facets include fluoroscopy , you can't bill another radiological code on the same day of service. You can bill facet and trigger at different sites appending the appropriate modifier. Make sure that you are using the correct ICD 10 CM code. Hope this helps!!
 
claudineerie@hotmail.com said:
I looked into NCCI and I noticed you are billing facets which include fluoroscopy and US guidance. NCCI states that you can only bill for 1 not both- this may be reason for denials. Since your facets include fluoroscopy , you can't bill another radiological code on the same day of service. You can bill facet and trigger at different sites appending the appropriate modifier. Make sure that you are using the correct ICD 10 CM code. Hope this helps!!
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This makes sense! If the doctor requires the use of Ultrasound for the trigger point or other injection in addition to the fluoroscopy, then he either needs to understand that he will not be reimbursed or choose to do those procedures on a different day. Thank you for your help!
 
You can apply the modifier 59 to the 76942 if they are using the u/s guidance for the trigger point injection. Those are not included in the TPI. If they ask for documentation, you can support that the imaging was not done for the facet joints and done for the TPI.
 
Alot of plans will not pay for trigger points and any other injection at the same visit, no matter what modifier you use. I informed my provider, showed him the denials, the appeals, and the denials. He made the decision that he didn't want to lose the money and told the patients that their insurance company considers it not separately payable at one visit, so they can come back another day or they can put pressure on their insurance company.
 
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