Wiki Trigger Point injections

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Good morning everyone, I have a question I am billing for Myoneural trigger point injections x 4 muscles
10 cc lidocaine 40mg kenalog ( This was performed in pain management office )
My question is : lidocaine is not billed ,correct?
for trigger point injections I coded them as
99214-25
20553- 59 ( 4units)
J3301 (4 units)

burnam

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Nicholls, GA
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Good Morning!
Can anyone tell me whether or not you can report the HCPCS injection code in addition to the trigger point injection codes (20600, 20610, 20552)? I know that you can't bill for the lidocaine, but we also in many cases inject depo medrol and wondered if we could be billing for that injectable code J1030? I see some articles that say it's all included and some that say you should always bill the HCPCS in addition to the administration code. I would greatly appreciate some clarification on this topic.
Thank you,
Nicole Burnam, CPC
 

hopepg

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Yes. The providers I work for bill the J1030 (& various others) for the med in addition to the administration code (2xxxx ...). Not a lot of reimbursement for the J code, but it adds up!
 

lhamilto@ufl.edu

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Micanopy, FL
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I don't think so.

Good Morning!
Can anyone tell me whether or not you can report the HCPCS injection code in addition to the trigger point injection codes (20600, 20610, 20552)? I know that you can't bill for the lidocaine, but we also in many cases inject depo medrol and wondered if we could be billing for that injectable code J1030? I see some articles that say it's all included and some that say you should always bill the HCPCS in addition to the administration code. I would greatly appreciate some clarification on this topic.
Thank you,
Nicole Burnam, CPC

I had this problem last week while trying to bill two gluteal trigger point injections (20552) with lidocaine. There is no code for injectable lidocaine, except for when it is being used intravenously (J2001) (correct me if I am wrong about this anyone), which is not the case here. There IS a code for unclassified drugs (J3490) that might work, but you'd have to then include documentation with the name of the drug. I then read somewhere that "Many payers do not allow separate reimbursement for local aesthetic, as they consider it to be part of the injection procedure." Since it was a commercial payer, I decided to just bill for the injections without the lidocaine.

Hope this helps.

Lisa Hamilton, CPC
 

CodingKing

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I had this problem last week while trying to bill two gluteal trigger point injections (20552) with lidocaine. There is no code for injectable lidocaine, except for when it is being used intravenously (J2001) (correct me if I am wrong about this anyone), which is not the case here. There IS a code for unclassified drugs (J3490) that might work, but you'd have to then include documentation with the name of the drug. I then read somewhere that "Many payers do not allow separate reimbursement for local aesthetic, as they consider it to be part of the injection procedure." Since it was a commercial payer, I decided to just bill for the injections without the lidocaine.

Hope this helps.

Lisa Hamilton, CPC

Billing for lidocaine used as primary anesthetic would be no different than billing separately for sutures or for making an incision. The fact its used for nearly every single injection of muscles, tendons, ligaments, joint, its already figured into the reimbursement rate for the procedure. In fact I heard some payers are starting to bundle Depo Medrol, Kenalog etc into injection procedures.
 
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Dallas
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Trigger point Injections

Nicole,

You should not charge for any of the "caines" (Lidocaine, Marcaine etc.) They are not normally reported in addition to the injection of the steroid medication. Your Medicare carrier as well as most private carriers will not cover the injection to numb things up. It is included in the trigger point injection. You will need to bill for the steroid medication (Kenalog, Depo-Medrol).
Lisa
 
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Location
Scotia, NY
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You can bill for the drugs used for the trigger point injections. However, it varies by carrier if they will pay them. It doesn't hurt to bill it and receive your denials so you can substantiate who pays and who doesn't. You may need to create a "zero charge" bill for these drugs if you match your inventory. This will allow you to correlate the amounts used with the amounts billed.

Hope this helps!

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