Documenting Trigger Point Injections for Better Reimbursement
Download as PPSX, PDF2 likes3,280 views
Trigger point injections are essential in managing muscle pain and require accurate documentation for medical billing. CPT and ICD-10 codes are provided for billing purposes, and specific criteria must be met for diagnosis under Noridian MAC policies. Proper documentation is crucial for reimbursement, and outsourcing medical billing can enhance accuracy and compliance.
Documenting Trigger Point Injections for Better Reimbursement
- 2. An integral part of comprehensive pain management, 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. Documenting trigger point injections is an important part of pain management medical billing. Trigger points may irritate the nerves around them and cause pain at the site of the trigger point or the pain can be felt in other parts of the body, including the back and neck. www.outsourcestrategies.com
- 3. CPT Codes for Trigger Point Injections 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 muscles When repeat trigger point injections are necessary, the medical record must reflect the reason for repeated injections. The patient’s response to the previous injection is an important factor in deciding any subsequent treatments. www.outsourcestrategies.com
- 4. ICD-10 Codes M46.01 Spinal enthesopathy, occipito-atlanto-axial region M46.02 Spinal enthesopathy, cervical region M46.05 Spinal enthesopathy, thoracolumbar region M46.08 Spinal enthesopathy, sacral and sacrococcygeal region M60.811 Other myositis, right shoulder M60.812 Other myositis, left shoulder ICD-10 codes indicating trigger point injections that the Medicare carrier will reimburse include: www.outsourcestrategies.com
- 5. M60.89 Other myositis, multiple sites M76.01 Gluteal tendinitis, right hip M76.02 Gluteal tendinitis, left hip M76.61 Achilles tendinitis, right leg M76.62 Achilles tendinitis, left leg M76.821 Posterior tibial tendinitis, right leg M76.822 Posterior tibial tendinitis, left leg M79.1 Myalgia M79.7 Fibromyalgia www.outsourcestrategies.com
- 6. Noridian MAC Policy Regional pain complaint Pain complaint or altered sensation in the expected distribution of referred pain from a trigger point Taut band palpable in an accessible muscle with exquisite tenderness at one point along the length of it Some degree of restricted range of motion, when measurable AAPM points out Noridian as one of the Medicare Administrative Contractors (MAC) to update its policies including LCDs for trigger point injections, with effect from May 26, 2017. Major criteria necessary to establish the diagnosis: www.outsourcestrategies.com
- 7. Reproduction of referred pain pattern by stimulating the trigger point Altered sensation by pressure on the tender spot Local response elicited by snapping palpation at the tender spot or by needle insertion into the tender spot Pain alleviated by stretching or injecting the tender spot According to Noridan’s policy, only one of four minor criteria is needed for the diagnosis: www.outsourcestrategies.com
- 8. Accurate Documentation Critical for Reimbursement In an article, National Government Services (NGS) cautions physicians against illegible documentation and “cookie cutter” physician notes which are a typical drawback of some EMR systems, “where all patients are getting the same procedure, with the same complaint, the same findings and the provider is treating them all with the same exact plan of care.” www.outsourcestrategies.com
- 9. What was the medication and how much was injected? How was the medication administered? Where was it administered? Who administered the medication? Did the patient have a reaction to the medication? Was any medication discarded? Was it medically necessary? The NGS article recommends that injection documentation answers the following questions: www.outsourcestrategies.com
- 10. Medical Billing Outsourcing - Ensure Appropriate Reimbursement Medical billing specialists at the physician’s office must be familiar with the diverse policies of all MACs which may vary in terms of the frequency and/or limitation of injections and documentation requirements. Outsourcing medical billing to an experienced service provider could be the best way to ensure accurate coding and documentation, and avoid the risk of audits. www.outsourcestrategies.com
- 11. CONTACT Headquarters: 8596 E. 101st Street, Suite H Tulsa, OK 74133 Main: (800) 670 2809 Fax: (877) 835-5442 E-mail: info@managedoutsource.com URL: http://www.outsourcestrategies.com