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iliopsoas tendon injection

  1. Default iliopsoas tendon injection
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    Hi All,

    I hope someone can help!

    DX Iliopsoas tendonitis.

    Proc. LT iliopsoas tendon injection.

    OP-note in short version Using fluoroscopic guidance in the AP view, I visualized the LT hip.Subcutaneous lidocaine was injected ov the entry site. Then, a22-gauge 5-inch needle was directed toward the neck of the femur. Boney contact was made. Then, the needle was withdrawn until spread of the iliopsoas muscle was seen using radiopaque dye. Dye was injected until we found the iliopsoas tendon spread. Then, 80 mg kenalog and 2ml of 1% lidocane, 2mL0.25%bupivacaine was injected. The needle was withdrawn.

    I'm looking at 20550 and 77002 but not sure this is correct. Also DX code.

    Any help will be appreciated

    Thank you

  2. #2
    726.5 Enthesopathy of hip region

    Bursitis of hip

    Gluteal tendinitis

    Iliac crest spur

    Psoas tendinitis

    Trochanteric tendinitis

    I looked at the Local coverage determination policy for WPS Medicare J5 for 20550 or 20552 and 726.5 is one of the conditions that meets medical necessity.

    Below it looks like for ICD-10 has a standalone code for this.

    Psoas tendinitis, unspecified hip

    Psoas tendinitis, right hip

    Psoas tendinitis, left hip

    __________________________________________________ _____________
    I believe you would use 20550 for injection around the tendon or tendon sheath versus using 20551 where the procedure note would have to describe injection at the tendon origin or insertion. It seems there can be some confusion if the physician is not aware of the different in these code descriptors on what is required to be documented to differ from the two codes.

    Below July 2012 CPT Assistant they are stressing the use of the descriptor in 20550 such as tendon sheath or ligament, although the descriptor does not specificaly state tendon I still personally believe this would be accurate code for what you are describe but another forum member or AMA CPT Network could confirm this is the CPT for the illopsoas tendon injection.

    AMA CPT Assistant July 2012
    Frequently Asked Questions

    Question: Are there circumstances in which code 20550 might be a more appropriate injection code to report for Dupuytren's contracture than the new CPT code 20527?

    Answer: No. Code 20550, Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia"), does not appropriately describe the injection procedure, as the injection is not made into the tendon sheath or ligament as the descriptor indicates, but rather, into the Dupuytren's cord. The injection for Dupuytren's contracture is more complex to perform than a therapeutic tendon sheath injection, as described by code 20550.

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