CPT 20550: TENDON SHEATH/LIGAMENT INJ

[Natasha2000]

Based on the CPT coding rules, not all of these tendon sheath/ligament injections (specifically the coccygeal ligament) will require a modifier. However, we have a seen a few claims get scrubbed back with this message: "The claim has been rejected stating: "payer has sent warning message through smartedit stating procedure code requires a valid modifier.". After reviewing the CMS Article A52863, it states: "Injection of separate sites (tendon sheath, ligament or ganglion cyst) during the same encounter should be reported on a separate line of coding and must have the modifier 59 appended. Multiple surgical rules will apply. Modifier 50 should not be reported with CPT codes 20551, 20552, 20553 or 20612, but may be reported, when appropriate, with CPT codes 20550 and 20526." The particular line in question is the wording "when appropriate, with CPT 20550". Is there really an anatomical modifier that can be appended if the injection is spanning the ligament? Or would that qualify as a bilateral injection? Please help!! We are stuck with clarification of this update on 02/10/2022 to CMS guidelines. Not even entirely sure that this has even changed from the revised article. Thank you for any advice on our concerns and questions.

 

[amyjph]

Where is this injection being performed? Are you reporting one line, one unit? Is that the only code being billed on that date/claim? I bet they want RT/LT if it's only one. For example, if biceps tendon injection on the RT side. Remember, sometimes payers and edits could vary. kind of like how some payers want bilateral on two lines, one unit, one RT, one LT while others want one line, one unit 50 mod, etc.
You don't get modifier 50 just for both "sides" of a ligament. That doesn't make sense.