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CostoSternal Injection, Bilateral

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Can someone help me with this procedure please? I know the costosternal injection is 20605 but not sure if I should bill units of bilaterally.



INDICATIONS: Chest and rib pain

DESCRIPTION OF PROCEDURE: After written informed consent was obtained from the patient, risks and benefits were discussed, including, but not limited to: Infection, pneumothorax, intravascular injection of Marcaine which could cause seizure and death. The patient was brought to the procedure room and placed supine on the fluoroscopic operating room table. Monitors were in place. The area of the sterum was prepped in sterile fashion.

After palpation revealed the 10 most sensitive areas, using a 25G 5/8" needle, 1 cc was injected at each site from a mixture of 8 mL of 0.50% Marcaine and 2 mL of 40 mg/mL Kenalog. These sites were along the lateral border of the sternum bilaterally, with 6 injections towards the left of the sternum and 4 towards the right, ranging from inferior to the sternal notch to superior to the xyphoid process. The needle contacted bone and was withdrawn slightly prior to each injection.

Afterwards, the puncture wounds were dressed. The patient tolereated the procedure well and was returned to the recovery room in stable condition.

any help is greatly appreciated.

Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management


True Blue
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20605 has a MUE (medically unlikely edit) by CMS of 4 units. I don't how the carrier would feel about being billed multiple units of 20605 for this type of procedure.