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Trigger point injections - billing software

  1. #1
    Cool Trigger point injections - billing software
    Medical Coding Books
    Hello! I'm totally new to Pain Management billing and have a questions about Trigger Point injections. Not sure if this is a rule that needs to be changed with our billing software or if it is infact correct.

    I'm billing CPT code 20552 and the patient has Medicare primary and PA Medicaid secondary. The dx code is 719.41. It will not drop to insurance, stating that Medicare does not support that dx code. I checked on Encoder Pro and it shows that it does. Is it truly not covered or should I have the rule checked into with the software company?

    Thanks for any input!

  2. #2
    North Carolina
    Medicare has a LCD on this procedure. According to your LCD, this DX is not covered. You'll need to query the physician if there is another, appropriate diagnosis.


  3. #3
    Thank you!!!

  4. #4
    Smile Trigger point injections
    Talk to your physicians because medicare allows diag;729.1 as only diagnosis for trigger points. Ck medicares lcd centers for all of the pain mangmnt codes. I've been coding pain mangmnt for last 2-years and we use medicare's lcd's almost as bible.

  5. #5
    726.19 might also be on your LCD which refers to shoulder region. Need to give the physician a copy of the LCD from your local Medicare carrier if they do this procedure often so they understand the criteria and diagnoses that they have designated as meeting medical necessity for the procedure.
    On your Encoder in the tool bar does it have a tab called LCD if not might have to get the more expensive verison if you want to access this from their program.

  6. Default
    Quote Originally Posted by thelma View Post
    Talk to your physicians because medicare allows diag;729.1 as only diagnosis for trigger points. Ck medicares lcd centers for all of the pain mangmnt codes. I've been coding pain mangmnt for last 2-years and we use medicare's lcd's almost as bible.
    You need to check the MC LCD for your region/carrier. Many MC carriers don't accept 729.1. There is technically no dx code for trigger points; however, there are resources which give lists of codes which can be chosen for the appropriate muscle groups. Anesthesia and Pain Answers is one of these. Also MC in my region has a list which can be used to determine the correct code. I have never seen a payer cover 719.41 though. If it's in the shoulder the most likely dx code would be 723.9 or 726.19 but you need to find out the specific muscle injected.

  7. Default
    Here are two links to MC LCDs. The first is WPS which does accept 729.1:


    The second is Cahaba GBA which does not. Both give lists of accepted diagnoses and the muscles that are associated with them.


    Hope this helps!

  8. Default 20550-20553
    Thank all for the info, I also use 719.41 with 20552, usually as the second dx, since i am re-entering billing/coding world after 5 years, i am finding lots of changes. My physician were billing 20550 but due to multiple rejects i found it was not allowed, now he wants to use 20551 along with his joint injections procedures, as he alsi does some tendon injection at same encounter. I welcome any info on these codes

  9. #9
    All I can recommend is to check the LCD or medical policy and provide a copy to the physician of conditions that are considered to meet the medical necessity for the procedure provided. Here is an example of Dxs but the guidelines will narrow this list down which ones they will accept.

    729.1 Myalgia and myositis, unspecified
    720.1 Spinal enthesopathy
    724.2 Lumbago
    728.85 Spasm of muscle
    723.1 Cervicalgia
    724.5 Backache, unspecified
    723.9 Unspecified musculoskeletal disorders and symptoms...
    726.5 Enthesopathy of hip region
    719.41 Pain in joint; shoulder region
    724.4 Thoracic or lumbosacral neuritis or radiculitis, u...
    726.19 Rotator cuff syndrome of shoulder and allied disor...
    726.90 Enthesopathy of unspecified site
    727.03 Trigger finger (acquired)
    729.5 Pain in limb
    722.52 Degeneration of thoracic or lumbar intervertebral ...
    726.10 Disorders of bursae and tendons in shoulder region
    724.3 Sciatica
    719.45 Pain in joint; pelvic region and thigh
    729.0 Rheumatism, unspecified and fibrositis
    729.2 Neuralgia, neuritis, and radiculitis, unspecified
    721.3 Lumbosacral spondylosis without myelopathy
    724.1 Pain in thoracic spine
    720.2 Sacroiliitis, not elsewhere classified
    847.0 Sprains and strains of other and unspecified parts...
    719.46 Pain in joint; lower leg
    724.02 Spinal stenosis, lumbar regio...

  10. #10
    Columbia, MO
    I have been using a pain code for all of my tigger points, tendon and joint injections which are performed for pain control. These are 338.xx codes. As long as the documentation specifies acut or chronic pain I can use a 338.xx code along with the site code for the pain or the definitive code for the joint degeneration or other problem. While it is not specified on the LCD, I still recieve reimbursement using the pain code and it is a documented diagnosis.

    Debra A. Mitchell, MSPH, CPC-H

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