Basics of trigger finger/point injection cpt code 20550-20551

The physician injects a therapeutic agent into a single tendon sheath, or ligament, aponeurosis such as the plantar fascia in 20550 and into a single tendon origin/insertion site in 20551. The physician identifies the injection site by palpation or radiographs (reported separately) and marks the injection site. The needle is inserted and the medicine is injected. After withdrawing the needle, the patient is monitored for reactions to the therapeutic agent.  Procedure/CPT code 20550 & 20551 are used to trigger finger injection cpt codes.

20550 Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar “fascia”)

20551 Injection(s); single tendon origin/insertion

Related trigger finger/point injection cpt codes

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

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The physician injects a therapeutic agent into a single or multiple trigger points of one or two muscles in CPT code 20552 and into a single or multiple trigger points for three or more muscles in CPT code 20552. Trigger points are focal, discrete spots of hypersensitive irritability identified within bands of muscle. These points cause local or referred pain. Trigger points may be formed by acute or repetitive trauma to the muscle tissue, which puts too much stress on the fibers.

The physician identifies the trigger point injection site by palpation or radiographic imaging and marks the injection site. The needle is inserted and the medicine is injected into the trigger point. The injection may be done under separately reportable image guidance. After withdrawing the needle, the patient is monitored for reactions to the therapeutic agent. The injection procedure is repeated at the other trigger points for multiple sites.

Documentation must include the site of the injection and number of injections and number of muscles.  Documentation must also support that conservative therapies has been tried and failed and in many cases payers what documentation that indicates the symptoms have persisted more than thee months and the trigger points have been identified by palpation.

Different payers have different payment policy, for example Aetna’s Medical policy states “It is not medically necessary to repeat injections more frequently than every seven days.  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.  Once therapeutic effect is achieved, it is rarely considered medically necessary to repeat trigger point injections more frequently than once every 2 months.”

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Reporting Injection of Amniofix for CPT code 20550 – 20551

If a patient with Achilles tendinosis received an injection of Amniofix to the left Achilles tendon. Based on the operative report the Amniofix was reconstituted with injectable saline and then injected into the Achilles tendon. Now, for this injection we do not have any specific CPT or HCPCS code, hence we have to report CPT code 20551, Injection(s); single tendon origin/insertion, for the Amniofix injection into the Achilles tendon.

Steroid Injection for Dupuytren’s Contracture

If a patient presents for treatment of Dupuytren’s contracture of the left hand and sesamoid arthritis. The pretendinous cords over the third and fourth metacarpals of the palm area were injected with 1% lidocaine and 10 mg of Kenalog. In such case report CPT code 20550, Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar “fascia”), for the steroid injection for treatment of the Dupuytren’s contracture. HCPCS code J3301, Injection, triamcinolone acetonide, not otherwise specified, 10 mg, would be reported for the substance administered.

New CPT codes have been added for Needle insertion without injection techniques (eg, dry needling, trigger-point accupunture). CPT code 20560 and 20561 are used for coding without injection for muscle using needle.

20560 Needle insertion(s) without injection(s); 1 or 2 muscle(s)

20561 3 or more muscles

The physician inserts a dry solid filament needle through the skin and into one or two muscles in 20560 and into three or more muscles in 20561. Indicated for myofascial pain relief and movement impairments, trigger points (focal, discrete spots of hypersensitive irritability identified within bands of muscle) are often the target of insertion. These points cause local or referred pain and may be formed by acute or repetitive trauma to the muscle tissue. This procedure, also known as dry needling or trigger-point acupuncture, does not involve the administration of injectable therapeutic agents.