Wiki CPT codes 20553 vs. 20552 cost error?

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MEbley

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Hi everyone!

I just started coding a few months ago and I have a question pertaining to CPT codes. I’m coding trigger point injections for a pain management practice, and the 20552 code comes up as $650, while the 20553 code comes up as $250. Doesn’t this seem backwards? Why would less work cost more than twice as much? Is this an error in the fee schedule, or is this normal? I can’t seem to get reasoning from anyone on this. I’m just told, “we don’t know, it’s always been like that.” Is it possible this is an error I should bring to my leaderships attention, or is this truly the case that 20552 is more expensive than 20553? Thanks so much!
 
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That is something that is specific to the practice you are working for. Every private physician practice chooses how much they want to charge for their services and those rates are entered into their system. They don’t come from an outside source, although many practices will base their rates as a percentage above what Medicare allows.

I agree with you that the rates don’t make sense. Also they seem very high for these services. I would expect 20552 to be around $150 rather than $650. Perhaps an error was made when the fee schedule was created and no one has ever gone back to correct or update the fees.

Most practices will review and update fees annually, when the new codes are released and need to be put into the system. Who is in charge of maintaining codes and fees in your practice’s system? You should bring this to their attention.
 
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These are the numbers that come up when I’m billing in-office procedures for our physicians. I enter the codes based on the office procedure that’s performed, and these are the billing dollar amounts that auto-fill for the procedures.
 
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Here are two examples to illustrate my confusion:

This morning I billed an in-office procedure where a physician did a trigger point injection x2 in the right lateral shoulder region, using .25% bupivacaine, and .5mg dexamethasone.

I billed a 20552 ($650), and a j1100-1 unit ($32). Cost: $682.

The second trigger point injection procedure was the same doc, only with this patient he did trigger point injections x7 in 3 sacral region muscles. Same med: bupivacaine/dexamethasone .5mg.

Cost on this one is $250 (20553), $128 (J1100-4 units)

I don’t choose the costs, they just auto fill when you enter the CPT codes, but I don’t understand why the 20552 is more than twice the cost of the 20553… it seems backwards. any thoughts?
 
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Thank you! My supervisor, I believe, is the one in charge of the fee schedule- she’s the revenue cycle manager. My hesitation with bringing it up again, is that she’s one of the people that told me, “we don’t know why it’s like that, it just always has been.” I really do feel this is an error though…
 
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MEbley said:
Thank you! My supervisor, I believe, is the one in charge of the fee schedule- she’s the revenue cycle manager. My hesitation with bringing it up again, is that she’s one of the people that told me, “we don’t know why it’s like that, it just always has been.” I really do feel this is an error though…
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An unfortunate response from a supervisor, but actually not that surprising to hear these days. Truthfully though, it's likely not a serious or urgent error to correct - insurance companies are going to pay what their contracts tell them to pay regardless of how much the provider charges. But perhaps bring it up in a different way at a different time with some additional errors if you find them. For example, by suggesting that your practice's fees appear to be out of date and need updating and opening a discussion about how that might take place. A colleague of mine used to say that sometimes you need to 'manage up' - in other words to find ways to lead your own supervisor into doing the right things on occasions when they don't know to take that initiative on their own.
 
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thomas7331 said:
An unfortunate response from a supervisor, but actually not that surprising to hear these days. Truthfully though, it's likely not a serious or urgent error to correct - insurance companies are going to pay what their contracts tell them to pay regardless of how much the provider charges. But perhaps bring it up in a different way at a different time with some additional errors if you find them. For example, by suggesting that your practice's fees appear to be out of date and need updating and opening a discussion about how that might take place. A colleague of mine used to say that sometimes you need to 'manage up' - in other words to find ways to lead your own supervisor into doing the right things on occasions when they don't know to take that initiative on their own.
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Love this suggestion. I will definitely use this approach. Thank you!!
 
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