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CPT 62310 with trigger point?

  1. Default CPT 62310 with trigger point?
    Medical Coding Books
    I have two questions.....

    1st... patient had a cervical epidural injection with a left medial parascapular trigger point injection and I'm wondering if I can bill both because cpt 62310 is bundled with 20552?
    Dx codes are cervical radiculopathy and left scapulocostal syndrome.

    2nd is patient had left L5-S1 transforaminal injection and trigger point injection of left buttock. Again the same thing but this time CPT 20552 is bundled with CPT 64483?
    Dx codes are low back pain status post discectomy and myalgia.


  2. Default
    Any takers on this one?

  3. #3
    St. Joseph County, Indiana
    Medicare will generally give you the big fat 'no'. A modifier '59' on the trigger point may help. With a '59' modifier, your odds of reimbursement is 30/70...not in your favor. Having good, separate dx's helps your cause. But remind the physcian that if he chooses to do this, it could be for free.

    The odds are better for commercial payers. Add the '59' and yell a lot and I think your odds go to 60/40. What you are fighting is that darn CCI edit...which can be tough

    Brock Berta
    Billing Czar

  4. #4
    Below, the following physician, Laxmaiah Manchikanti, MD, wrote to medical director of the National Correct Coding Initiative and address among other edits, the following:

    "Column 1 Codes 20552 and 20553 are included in Column 2 with 1 modifier (allowed)
    CPT codes 62310, 62311, 62318, 62319, 64408, 64410, 64435, and 64455, which are
    epidurals and multiple nerve blocks. Our concern is mainly with 62310 and 62311.
    Unfortunately this will not always apply. A patient may have a trigger point injection in
    the cervical region. Thus, if trigger point injections are billed, one cannot bill for an
    epidural injection with 62311; likewise, if a trigger point injection is performed in the
    lumbosacral area, one cannot perform 62310, the cervical epidural injection.
    This creates questions in the minds of physicians in providing care. Further, most
    providers have been experiencing an inability to override with modifier 59 as Medicare is
    considering to pay only for the lowest code and decide not to pay for the other codes.
    This will create further appeals, which may not be worthwhile, as it will create too many
    problems. Even though this may not be a strategic issue for you, it is extremely important
    in providing care. To override this, providers will be calling patients to return on multiple
    occasions or they may just stop doing the procedures or billing them, which can result in
    a loss to the providers."

    Like he mentions the codes with the higher RVUs ( 62310 and 62311) are column two codes to column one code 20552. Currently, I am not aware of any document that explains when modifier 59 would be appropriate with some of the edits they do with pain management procedures. A different anatomical site is seen such as how the shoulder is described below

    "From an NCCI perspective, the definition of different anatomic sites includes different organs or different lesions in the same organ. However, it does not include treatment of contiguous structures of the same organ. For example, treatment of the nail, nail bed, and adjacent soft tissue constitutes treatment of a single anatomic site. Treatment of posterior segment structures in the ipsilateral eye constitutes treatment of a single anatomic site. Arthroscopic treatment of a shoulder injury in adjoining areas of the ipsilateral shoulder constitutes treatment of a single anatomic site."

    In his letter he describing a scenario of a cervical area trigger point with a lumbar epidural and stating other providers not be able to receive reimbursement or "override" the edit. I am not currently seeing trigger points and epidurals performed in the same setting so I don't have a lot of experience with the carrier's response. What you describe seems like anatomically they are different sites for different conditions and in my personal opinion the modifier 59 would be appropriate but this is soley my interpretation and not based on a published article.

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