PRINCIPLES OF INJECTION CODING - apma.org
[Pages:8]PRINCIPLES OF INJECTION CODING
Rick Horsman, DPM Olympia, WA
ELEMENTS/COMPONENTS OF INJECTION CODING
COMPONENTS:
Determine need for injection (E/M)
Injection Itself
(Injection CPT code)
Injection Therapeutic Supply (HCPCS)
"GLOBAL SERVICES"
Can not bill for anesthesia for surgery Can not bill for post-operative nerve blocks Can not bill for intra-operative "Trigger
point" injections If patient is coming to office expecting
injection, NO E/M billable
e.g. Plantar fasciitis, Neuroma
INJECTION CODES
20550
Tendon Sheath or Ligament; Plantar fascia
20551
Tendon Origin or Insertion
20600
Inject/Aspirate "Small" Joint
20605
Inject/Aspirate "Intermediate" Joint (midfoot)
20612
Inject/Aspirate Ganglion Cyst(s)
64450
Inject Peripheral Nerve (non-interdigital)
64455
Inject interdigital Neuroma
64999
Destruction of Interdigital Nerve (via injection, etc.)
requires at least 50% alcohol solution
(64640 does not seem to be the appropriate CPT code for sclerosing injections; at least at
this time) (Fanucci et al: Eur Radiol 14:514-518; 2004)
IMAGING GUIDANCE
There ARE CPT codes that provide for additional reimbursement for use of flouroscopy, etc. utilized to assist in performing injections
The vast majority of injections in the foot and ankle do not require imaging guidance
Therefore, not medically necessary
INJECTION OF PERIPHERAL NERVES
So... it would appear that...
Any diagnostic and/or therapeutic injection of any peripheral nerve (other than of common plantar nerve / "interdigital neuroma") can appropriately be billed via CPT 64450, plus applicable therapeutic supply
THERAPEUTIC SUPPLY
The local anesthetic components of the injection are not separately billable
ONLY therapeutic supply can be billed separately (antiinflammatory, etc.)
INJECTION SUPPLY
Injected supply billed with HCPCS "J" codes Do NOT bill for the local anesthetic (lidocaine, etc.) J1020-30 methylprednisolone acetate (Depo-Medrol) J1094 dexamethasone acetate (Decadron LA) J1100 dexamethasone sodium phosphate J3301-3 triamcinolone (Kenalog) Code based upon total mg applied on date of service;
even if applied over multiple sites
Use applicable modifiers to reflect separate sites
LT, RT, -59 Modifier
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