is 20552 the cpt code for a trigger point injection with icd 10 m54.12

CPT 20552 and CPT 20553 are for trigger point injections, and they are related to muscular knots, Myofascial pain, and musculoskeletal disorder. CPT 20552 CPT 20552 code is specific for trigger point injection (s) at multiple points of 1 or 2 muscles, I.e., Active Myofascial Trigger Point at Trapezius and deltoid muscle.

Full Answer

What does 20552 mean in CPT code?

CPT CODE 20552, 20553 - Trigger point injection - Medical billing cpt modifiers and list of Medicare modifiers. 20552 Injection (s); single or multiple trigger point (s), 1 or 2 muscle (s) 20553 Injection (s); single or multiple trigger point (s), 3 or more muscle (s)

What are 20553 injections?

20553 Injection (s); single or multiple trigger point (s), 3 or more muscle (s) Trigger Point Injections are used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax.

What is the CPT code for multiple trigger points?

The codes for reporting TPs include: Injection (s); single or multiple trigger point (s); 20552 1 or 2 muscle (s) 20553 3 or more muscles

What is the trigger point injection code 20552?

Its billing under the trigger point injection code is a misrepresentation of the actual service rendered. Only one code from 20552 or 20553 should be reported on any particular day, no matter how many sites or regions are injected.

What is CPT code 20552 used for?

For trigger point injections, use code 20552 for one or two muscle groups injected, or 20553 for three or more muscle groups. The number of services for either code is one (1), regardless of the number of injections at any individual site, and regardless of the number of sites.

What ICD 10 codes cover trigger point injections?

Coding Trigger Point Injections for Pain Management20552-Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)20553-Injection(s); single or multiple trigger point(s), 3 or more muscles.

What is the CPT code for trigger point injection?

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

How do I bill a CPT 20552?

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 ...

Does CPT code 20552 need a modifier?

Key point to remember! - these 2 CPT Codes 20552, 20553 DO NOT NEED A MODIFIER!

What diagnosis covers trigger point injections?

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.

What is the difference between CPT code 20550 and 20552?

The musculoskeletal therapeutic injection codes 20550 through 20553 have been revised to read as follows: 20550, Injection(s); tendon sheath, ligament; 20551, Tendon origin/insertion; 20552, Single or multiple trigger point(s), one or two muscle(s);

Does CPT code 20552 include the medication?

Because this code specifies a number of muscles injected, not a particular amount of medication or number of injections, you'll report 20552 because only two muscles (trapezius and levator scapulae) were injected.

How do you document a trigger point injection?

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.

Can you bill an office visit with a trigger point injection?

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.

Can CPT code 20552 be billed bilaterally?

Trigger points are by muscle(s) injected; 20552 is 1-2 muscles, 20553 is more than 3 or more muscles. He injected 4 muscles (2 paraspinal and 2 trapezius) so the code billed is 20553. Additionally, these codes are not reported bilaterally with a 50 modifier or with an RT/LT.

Can 20610 and 20552 be billed together?

Does that mean I can't bill both if I do both at the same encounter? Answer: You are correct, trigger point injection (20552 or 20553) and a joint injection, for example, a shoulder joint injection, (20610) are bundled by Medicare. You will note, however, that a modifier is allowed to override this edit.

How many injections are in 20552?

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.

What is a trigger point in a muscle?

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, ...

What is a TP injection?

The TPs are injected with either a numbing agent, steroid, or another substance used to relax or decrease inflammation within the knotted muscle.

What is 20553 injection?

20553 Injection (s); single or multiple trigger point (s), 3 or more muscle (s) Trigger Point Injections are used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Trigger points may irritate the nerves around them and cause pain at the site of the trigger point or ...

What is the CPT code for a single trigger point?

CPT/HCPCS Codes. 20552 Injection (s); single or multiple trigger point (s), one or two muscle (s) 20553 single or multiple trigger point (s), three ...

What is trigger point in myofascial pain?

Myofascial trigger points are self-sustaining hyper-irritative 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); each of these single muscle syndromes is responsive to appropriate treatment. To successfully treat chronic myofascial pain syndrome, each single muscle syndrome needs to be identified along with every perpetuating factor.

What is the trigger point injection?

Trigger point injections involve injection of local anesthetic, saline, dextrose, and/or cortisone into the trigger point.

What is the best way to treat trigger points?

stretch and use of coolant spray followed by hot packs and/or aerobic exercises; application of low intensity ultrasound directed at the trigger point (this approach is used when the trigger point is otherwise inaccessible); deep muscle massage; injection of local anesthetic into the muscle trigger points:

What is trigger point in skeletal muscle?

Trigger points are areas of taut muscle bands or palpable knots of the muscle, that are painful on compression and can produce referred pain, referred tenderness, and/or motor dysfunction. A trigger point may occur in any skeletal muscle/fascia in response to strain produced by acute or chronic overload.

What is the treatment for myofascial pain syndrome?

After making the diagnosis of myofascial pain syndrome and identifying the trigger point responsible for it, the treatment options are: medical management, including the use of anti-inflammatory agents, tricyclics, etc.; stretch and use of coolant spray followed by hot packs and/or aerobic exercises;

General Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

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.

Article Guidance

The following coding and billing guidance is to be used with its associated Local coverage determination.

ICD-10-CM Codes that Support Medical Necessity

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.

ICD-10-CM Codes that DO NOT Support Medical Necessity

All ICD-10-CM codes not listed in this policy under ICD-10-CM Codes That Support Medical Necessity above.

Bill Type Codes

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.

Revenue Codes

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.

General Information

CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

Title XVIII of the Social Security Act, Section 1833 (e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period..

Article Guidance

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L35010, Trigger Point Injections. Please refer to the LCD for reasonable and necessary requirements.

ICD-10-CM Codes that Support Medical Necessity

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted. The following ICD-10 CM codes support medical necessity and provide coverage for CPT/HCPCS codes 20552 and 20553:

ICD-10-CM Codes that DO NOT Support Medical Necessity

All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this policy.

Bill Type Codes

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.

Revenue Codes

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.

What is trigger point injection?

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.

What is the CPT code for MPS?

There are two CPT ® codes for Trigger point injections: 20552-Injection (s); single or multiple trigger point (s), 1 or 2 muscle (s) ...

How many sets of injections are needed for pain?

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.

What is MPS pain?

MPS is a chronic condition affecting the connective tissue (i.e., fascia) surrounding the muscles; sensitive points in your muscles (trigger points) cause referred pain in seemingly unrelated parts of the body. MPS typically occurs after a muscle has been contracted repetitively.

What is 20552 injection?

20552 = Injection (s); single or multiple trigger point (s), one or two muscle (s) Modifiers LT or RT are not valid for 20552 because trigger points and muscles exist throughout the body, not in only two paied locations. 1.

What is trigger point injection?

Trigger point injections. Trigger point injection refers to the injection of local anesthetics or anti-inflammatory medications into myofascial trigger points. Trigger points are self-sustaining irritative foci that occur in skeletal muscle in response to strain, as well as mechanical overload phenomena.

How often should trigger point injections be performed?

With this intent, it is expected that trigger point injections may be performed as frequently as a monthly interval from the time of onset of illness or injury for the first three sets of injections of a treatment course, and as frequently as every two months thereafter for an additional three sets of injections.

What is the best way to treat trigger points?

stretch and use of coolant spray followed by hot packs and/or aerobic exercises; application of low intensity ultrasound directed at the trigger point (this approach is used when the trigger point is otherwise inaccessible); deep muscle massage; injection of local anesthetic into the muscle trigger points:

What is the treatment for myofascial pain syndrome?

After making the diagnosis of myofascial pain syndrome and identifying the trigger point responsible for it, the treatment options are: medical management, including the use of anti-inflammatory agents, tricyclics, etc.; stretch and use of coolant spray followed by hot packs and/or aerobic exercises;