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    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.

  1.        20552 - Injection(s); single or multiple trigger point(s), one
    or two muscles
  2.        20553 - Single or multiple trigger points(s), three or more

    Global Days: 0

    *** Imaging/Radiology Crosscodes:

    76942         Ultrasonic guidance for needle placement (eg, biopsy,
    aspiration, injection, localization device), imaging supervision and

    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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