Coding for Trigger Point Injections:
"Trigger points are described as hyper irritable spots in skeletal muscle that are associated
with palpable nodules in taut bands of muscle fibers. Trigger point researchers believe that
palpable nodules are small contraction knots and a common cause of pain."
What Causes Trigger Points? It could be due to or but not limited to:
Injuries (e.g. whiplash)
Daily activities (especially of that are work-related) of repetitive movements (e.g. typing, data
entry)
Lack of exercise, stress and poor posture
Lack of activity
Poor back support
Poor sleeping position
The trigger point codes are very specific and only has two codes.
- 20552 - Injection(s); single or multiple trigger point(s), one or two muscles
- 20553 - Single or multiple trigger points(s), three or more muscles
Global Days: 0
*** Imaging/Radiology Crosscodes:
76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection,
localization device), imaging supervision and interpretation
77002 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection,
localization device)
Trigger point injections must be billed one line regardless how many injections. For instance,
if your pain doc performed trigger points on 2 muscles, report 20552 x 1 unit... (not 2 units for
2 muscles!)
CPT 20553 is NOT an add-on code!
Modifier -59 should not be used with these codes.
Modifier –25 can be appended for E/M office visit if done on the same day and such is
separate and identifiable medically necessary. Above and Beyond.
Documentation in the patient’s medical record should include proper evaluation leading to the
diagnosis of the trigger points, specific identification of the affected muscle(s). It must also be
properly documented the reason why injections are the chosen as a treatment option.
Here's a part of AMA's Question and Answer Per CPT Assistant May 2003
Question: “My physician performed two trigger point injections in two different muscles.
Would it be appropriate to report code 20552 twice for the two injections?”
AMA Comment: “Code 20552-20553 are reported one time per session, regardless of the
number of injections or muscles injected. Therefore, it would not be appropriate to report
code 20552, Injection(s); single or multiple trigger point(s), one or two muscle(s) twice for the
two injections administered.”
**** CPT is owned by the American Medical Association (AMA)
**** For more references: Consult your CPT code books. The National Correct Coding
Initiative (NCCI) and third pary payer payment policies and guidelines
**** CPT Assistant September 2003
**** Always refer to your local carrier's LCDs
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