Wiki Trigger Point question

[sfabrico]

Hello!

We've been having issues getting our trigger points paid by Medicare. They pay one level, but if it's bilateral or an additional level we've been having issues getting them reimbursed. We've tried using the '50' modifier as well as the '59' modifier. Has anyone else come across this issue? If so how did you rectify it?

Thank you!
Sami

 

[mitchellde]

Trigger point injections use the 20552 or 20553 codes you can bill only one with one unit and no bilateral modifier allowed. 20552 is for up to 2 muscles and 20553 is 3 or more.

 

[sfabrico]

Thanks Debra! I appreciate it!

 

[lisa92]

Would you code left and right trapezius plus left rhomboid trigger points as 2 or 3 muscles. We are trying to figure out if the trapezius is one or two muscles?

 

[dwaldman]

Lisa92,
I don't believe the AMA has published through CPT Assistant or CPT Changes the answer to this question separate . I was thinking about writing them about that type of scenario. Maybe another forum member has a better understanding on how to determine an appropriate way to determine between the codes without AMA specific guidance. I have counted by separate muscle with the scenario you provided, in the past I have selected 20552 for two separate muscles by name, but maybe someone else has a different viewpoint.

 

[mitchellde]

Would you code left and right trapezius plus left rhomboid trigger points as 2 or 3 muscles. We are trying to figure out if the trapezius is one or two muscles?

You have two separate trapezius muscles one on the right and one on the left if you inject both of these you have injected two separate muscles. Plus the rhomboid would then equal three separate muscle injections.
This is different from injecting the same muscle in two different locations, that would be only one muscle injected.