For a list of ICD-10-CM codes that may support medical necessity for trigger point injections, be sure to look up 20552 or 20553 in findacode.com and on the code page click on the tab titled "Cross-A-Code" for a list of Medicare-approved ICD-10-CM codes that support medical necessity for these codes.
Trigger points are focal areas of muscle spasm, (often located in the upper back and shoulder areas) that develops when a small portion of myofascia (the tissue covering the muscle) tightly contracts to itself by cutting off its blood supply and preventing the underlying muscle from working properly.
This contractor may request records when it is apparent that patients are requiring a significant number of injections to manage their pain. These are the only covered ICD-10-CM codes that support medical necessity. This A/B MAC will assign the following ICD-10-CM codes to indicate the diagnosis of a trigger point.
A common nonarticular rheumatic syndrome characterized by myalgia and multiple points of focal muscle tenderness to palpation (trigger points). Muscle pain is typically aggravated by inactivity or exposure to cold.
A Medicare beneficiary must be diagnosed with myofascial pain syndrome (MPS), which is a chronic pain disorder, in order for Medicare to cover trigger point injections. A doctor or provider will review the beneficiary's medical history and complete an exam of the patient to make this diagnosis.
When coding for trigger point injections, the documentation must include the site of the injection, the total number of injections and the number of muscles involved. In addition, documentation must also support that various conservative therapies have been tried and failed.
Effective March 1, 2017, Any combination of trigger point injections, CPT codes 20552 (Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)) and 20553 (Injection(s); single or multiple trigger point(s), 3 or more muscles), when billed >3 times in a 90-day period, for the same anatomic site, without ...
Trigger point injections are a pain management treatment that involves injecting a local anesthetic, sometimes combined with a steroid medication, into a trigger point to relax muscles and relieve pain.
20552-Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)
Group 1CodeDescription20552INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MUSCLE(S)20553INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 3 OR MORE MUSCLES
The office visit is allowed and should be billed with the modifier -25 because the decision to give the injections was made after the examination.
ICD-10-CM Code for Myalgia M79. 1.
CPT code 20550 defines an injection to the tendon sheath; CPT code 20551 defines an injection to the origin/insertion site of a tendon. CPT code 20550 is frequently used for a trigger finger injection, where the injection is administered to the tendon sheath.
A trigger point injection is an outpatient procedure designed to reduce or relieve the back pain caused by trigger points, which are small knots that form in muscles or in the fascia tissue leading to pain caused by muscle irritation (myofascial pain).
Trigger point injections are not truly nerve blocks; rather they are muscle blocks. Muscles that are chronically tense or in spasm become tender and painful.
Trigger point injections are the second treatment option, and these injections contain either a steroid (cortisone) or plant-based medicine (sarapin) to loosen the trigger point and reduce pain.
Trigger point injection therapy is a common procedure performed by pain management specialists, orthopedic surgeons, physical medicine and rehab and other specialties. Trigger point injection therapy is used for the treatment of myofascial pain syndrome (MPS). According to the American Society of Regional Anesthesia and Pain Medicine.
There are two CPT ® codes for Trigger point injections: 20552-Injection (s); single or multiple trigger point (s), 1 or 2 muscle (s) ...
Up to 4 sets of injections are considered medically necessary to diagnose the origin of the patient’s pain and to achieve a therapeutic effect; additional sets of trigger point injections are not considered medically necessary if not clinical response is achieved.
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Title XVIII of the Social Security Act, §1862 (a) (1) (A). Allows coverage and payment for only those services that are considered to be medically reasonable and necessary. Title XVIII of the Social Security Act, §1833 (e). Prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
The following coding and billing guidance is to be used with its associated Local coverage determination.
These are the only covered ICD-10-CM codes that support medical necessity. This A/B MAC will assign the following ICD-10-CM codes to indicate the diagnosis of a trigger point. Claims without one of these diagnoses will always be denied.
All ICD-10-CM codes not listed in this policy under ICD-10-CM Codes That Support Medical Necessity above.
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
Those knots are referred to as trigger points and they can be very painful. As a matter of fact, a trigger point (TP) in one area can cause surrounding muscles to tighten or spasm, increasing pain and discomfort for the patient. Over-the-counter pain medications, anti-inflammatories, or even a good massage, may help to alleviate some symptoms, ...
Three injections were given into the right shoulder (no specific muscle noted). This is counted as 1 unit of 20552. Four injections into the right gluteus maximus and two into the right biceps femoris were administered is counted as two muscles or 20552.
The TPs are injected with either a numbing agent, steroid, or another substance used to relax or decrease inflammation within the knotted muscle.
CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for trigger point injections. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy.
Compliance with the provisions in this LCD may be monitored and addressed through post payment data analysis and subsequent medical review audits. History/Background and/or General Information Trigger point injection is one of many modalities utilized in the management of chronic pain.
M60.-) (my-al-juh) pain in a muscle or group of muscles. A chronic disorder of unknown etiology characterized by pain, stiffness, and tenderness in the muscles of neck, shoulders, back, hips, arms, and legs. Other signs and symptoms include headaches, fatigue, sleep disturbances, and painful menstruation.
Clinical Information. (my-al-juh) pain in a muscle or group of muscles. A chronic disorder of unknown etiology characterized by pain, stiffness, and tenderness in the muscles of neck, shoulders, back, hips, arms, and legs.
The diagnosis of trigger points requires a detailed history and thorough physical examination. The following clinical symptoms may be present when making the diagnosis: History of onset of the painful condition and its presumed cause (e.g., injury or sprain)
Myofascial trigger points are self-sustaining hyperirritative foci that may occur in any skeletal muscle in response to strain produced by acute or chronic overload. These trigger points produce a referred pain pattern characteristic for that individual muscle. Each pattern becomes part of a single muscle myofascial pain syndrome (MPS) ...
It is expected that trigger point injections would not usually be performed more often than three sessions in a three month period.