Question Prolotherapy vs joint injections


Best answers
We have an ongoing debate regarding prolotherapy vs joint injection billing in our Dept.
The provider considers a joint injection with dextrose/saline and lidocaine a normal CPT 20610 type injection, i.e. in the knee or hip.
However, all publications I have read take you to prolotherapy since the solution injected is dextrose and saline.
Does anyone else bill for this type of service and if so, do you have any publications to support from CMS, etc...?


Cedar Rapids, IA
Best answers
I agree with your assessment of prolotherapy. The HCPCS description of M0076 is:

Prolotherapy is also known as proliferative injection therapy or sclerotherapy. The practice of prolotherapy is used by physicians to treat a number of different types of chronic pain. Prolotherapy consists of a series of trigger point injections of "proliferative" solutions into ligaments and tendons near the pained area to induce the proliferation of new cells. Proponents of this treatment suggest that looseness in the supporting ligaments and tendons around the joints causes the pain, inducing the muscles to contract against the ligament and irritate the nerve endings. Three types of solutions are used to initiate inflammation: chemical irritants (e.g., phenol), osmotic shock agents (e.g., hypertonic dextrose and glycerin), and chemotactic agents (e.g., morrhuate sodium, a fatty acid derivative of cod liver oil). These injections irritate or inflame the area where they are injected and are intended to mimic the natural healing process by causing an influx of fibroblasts that synthesize collagen at the injection site, leading to the formation of new ligament and tendon tissue. The newly produced collagen is intended to support the injured or loosened ligaments, creating a more stable and strong muscle base, in the process, alleviating pain.

Unfortunately it isn't a covered charge as it is still considered experimental so the patient should be made aware it will be an out of pocket expense.