Injection FAQs

Below are answers to key questions about billing injection services in rheumatology practices.

Can multiple trigger point codes be billed on the same encounter?

No, the trigger point codes are based on the number of muscles injected. Each code gives a descriptor of how many muscles are allowable to be billed. CPT code 20552 is for an injection, single or multiple trigger points, 1 or 2 muscles, and the CPT code 20553- single or multiple trigger points, 3 or more muscles. So, this simple means that if you injected 3 or more muscles, you can only bill CPT 20553 as 1 unit for the procedure.

What is the difference between coding for an injection of the tendon sheath and the tendon origin?

These are defined by two separate codes in CPT. Injection of the tendon sheath is coded with CPT 20550 and the injection of the tendon origin is coded with CPT 20551.

What CPT code should be used for injection of the sacroiliac joint?

CPT code 27096 should be used – this is defined as “Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed.” Note, the imagining for guidance with fluoroscopy or CT is built in the descriptor of the code and should not be billed separately. If no guidance is used, then it is requires to bill using CPT code 20552.

When coding for bilateral joint injections, what modifier is needed?

There are three acceptable ways to bill for bilateral codes (1.) The procedure can be billed on both lines; one code should be billed with the amount of units on the first line and on the next line place modifier -50 on the second procedure code. (2.) Both codes can be billed on line one and two and place the laterality modifiers LT and RT as needed on both procedure codes. (3.) The final way is to bill only one procedure with the total amount of combined charges on one line and place modifier-50 in the appropriate field. As with all billing guidelines, make sure to verify with the carrier as to which way is acceptable to bill for a bilateral procedure.

Can the ultrasound guidance code 79642 and a joint injection 20600, 20605 or 20610 be billed on the same encounter?

No, as of January 1, 2015, there are a total of six possible codes to reflect an injection with ultrasound guidance. Note, CPT code 76942 is combined into three new joint injection codes that indicate guidance was performed with this procedure and should not be billed on a separate line. Please make sure your systems are updated to reflect the new codes.

  • 20604 Arthrocentesis, aspiration and/or injection small joint or bursa (e.g., fingers, toes) with ultrasound guidance, with permanent recording and reporting
  • 20606 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (e.g., temporomandibular, acromioclavicular, wrist, elbow, ankle, olecranon bursa) with ultrasound guidance, with permanent recording and reporting
  • 20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa) with ultrasound guidance, with permanent recording and reporting. If no guidance was used for the injection, then CPT codes 20600-20610 will be billed based on the anatomical site.

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