ASGE members may submit coding inquiries electronically to codingquestions@asge.org. Each month ASGE gets dozens of questions from members. When submitting a question, please allow at least three business days for a response. When submitting inquiries, please include the ASGE member’s name and ID number. Only questions will be accepted and not reports. Full patient and practice information is a violation of HIPAA privacy rules and questions will be sent back without an answer. Below are two distinct questions on iron infusions and trigger point injections.
Question #1
I need information on iron infusions. What are the CPT codes that would be billed for this? In my research I found CPT code J1756 but I am not sure this is the most appropriate drug code. Are there any known issues with billing for these?
Answer #1
Iron infusions are ICD-10 dependent. Make sure that your physicians document the specific type of iron deficiency anemia (IDA) and have lab studies to confirm the diagnosis. Pre-authorization and verification of eligibility are recommended. Also, check payer websites for information on iron infusions.
CPT codes:
- 96374 if IV infusion less than 15 minutes
- 96365 if IV infusion greater than 15 minutes
- 96366 for each additional hour
Additional websites for billing:
- Injectafer
- Injectafer: (J1439) NDC info
- Venofer (has no billing information online but a hotline number available on the website): (J1756) NDC info
Question #2
We have a GI provider who wants to provide trigger point injections to provide pain relief to patients who have abdominal musculoskeletal pain and have not been able to find relief. Are insurances typically covering these injections? Also, I am finding the following CPT codes. Are they correct?
- 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)
Answer #2
Yes, 20550 and 20553 are the correct procedure codes. The steroid medication is billable but not the anesthetic agent which is often mixed in with the steroid. As for reimbursement, some payer policies are diagnosis driven. So, check your local coverage determinations (LCDs) for Medicare and commercial policies since there are documentation requirements, and the diagnosis code of abdominal pain may not be payable. As with any procedure that might be performed, please verify patient eligibility before performing the procedure.
An example from Novitas Solutions for LCD Trigger Point Injections (L35010).
The diagnosis of trigger points requires a detailed history and thorough physical examination. The following clinical symptoms may be present when making the diagnosis:
- History of onset of the painful condition and its presumed cause (e.g., injury or sprain)
- Distribution pattern of pain consistent with the referral pattern of trigger points
- Range of motion restriction
- Muscular deconditioning in the affected area
- Focal tenderness of a trigger point
- Palpable taut band of muscle in which trigger point is located
- Local taut response to snapping palpation
- Reproduction of referred pain pattern upon stimulation of trigger point