Understanding Trigger Finger Injection CPT Codes: Best Practices for Accurate Claims
Trigger finger, also known as stenosing tenosynovitis, is a painful condition that occurs in the fingers. It causes stiffness, almost as if the fingers are locked. This condition is often the result of inflamed flexor tendons in the fingers. This inflammation in the flexor tendons is what inhibits the ability of the fingers to move freely.
To treat this ailment, the first thing to do is try to reduce the inflammation by using corticosteroid injections. This, however, is not the focus of this article. If you want to learn more about this condition and its treatment, you can visit: https://www.assh.org/.
In this article, we will be looking at billing issues that health service providers encounter when dealing with claims for this treatment. The only way to ensure accurate billing and claims is to have a full understanding of the prevalent CPT (Current Procedural Terminology) codes with respect to trigger finger injections. To help you with this, we will be looking extensively at the trigger finger injection CPT codes, how to ensure accurate claims and some common challenges that can lead to errors in billing.
The Basic CPT Codes for Trigger Finger Injections
Incorrect coding is one of the main reasons for claims denials. It is therefore important that these codes are correctly used.
Below is the main trigger finger injection code:
CPT Code 20550
This code describes a single tendon sheath, or ligament, aponeurosis injection. It is used when the injection is administered into the tendon sheath of the finger being treated.
CPT Code 20551
This code refers to a single tendon origin injection. It is used when the injection is administered to the tendon's origin and not within the sheath.
Using Modifiers
Modifiers are like additional codes added to the original code to indicate that additional injections were administered. These are necessary when injections have been administered on different fingers as part of a single treatment.
Some of the main modifiers used include:
Modifier -50
This is used to indicate a “Bilateral Procedure”, or a case where the injection is administered on the two hands.
Modifier -59
Also referred to as the “Distinct Procedural Service”, this modifier is used to indicate that multiple injections were administered to different parts of the body.
Modifier -LT or –RT
This modifier distinguishes between the left and the right sides to ensure clarity.
Steps to Ensuring Accurate Billing and Claim Submission
To ensure accurate billing and claims submission, certain best practices must be adhered to. Let's discuss these best practices.
Proper Documentation
Proper documentation is crucial and most be done right if claims will be successful. Before submitting claims, ensure that the medical records submitted for each patient includes the following:
· ICD-10 code M65.3 – this is the code that shows the diagnosis of trigger finger
· Procedure notes to include how many fingers were treated and the exact points where they were injected.
· Name of drug administered, dosage and technique
· Response of the patient and any plans for follow-up care
Insurance Coverage Verification
Before commencing with any treatment, be sure to first confirm that the patient’s insurance cover is adequate. You should also find out if the insurer requires that prior authorization is gotten before the treatment is administered.
Use of Correct CPT Codes and Modifiers
This is one easy way to have claims denied. It’s therefore important that the correct trigger finger injection cpt codes are used always. Any errors in this area will lead to an automatic denial of claims.
Say No to Upcoding and Downcoding
Whether as an error or otherwise, making an incorrect claim can result in compliance issues or straight denial. There are two types - claims for a more complex procedure than what was actually performed (upcoding) or claims for a less complex procedure than what was performed (downcoding). Any of these should be avoided.
Avoid Late Claims Filing
Some insurers have a deadline by which claims must be filed. Be sure that you are aware of this so your claim is not rejected because it came late.
Solutions to Common Billing Challenges
There are a few billing challenges that many providers often encounter. We will look at a few of the reasons why bill claims are often denied.
1. Lack of Medical Necessity
If the insurer decides that the injections were not required, hence the name “lack of medical necessity”, then the claim will be denied. To ensure that this does not happen, you should do the following:
· Maintain a clear medical record that shows that the patient required the treatment
· Show any previous treatments that did not provide the required result, necessitating the need for the injection(s)
· Ensure that the claim includes the correct ICD-10 code (M65.3)
2. Confusing CPT Code 20550 with 20551
You do not want your claims to be denied or sent for audit so you should therefore ensure that these codes are used correctly. Remember that 20550 should be used when the injection is administered into the tendon sheath. On the other hand, 20551 should be used if the injection is administered at the insertion of origin of the tendon.
3. Incorrect Modifiers
Modifiers are necessary, especially when multiple treatments have been administered as part of a treatment. Ensure that these modifiers are used correctly to reduce the occurrence of denials.
4 Bundled Payments
This is a case where the payer lumps multiple treatments together and pays for it as a single treatment. It means that you are being underpaid for the treatments given and can often be caused by unclear documentation.
To ensure that this does not happen, note the following:
· Ensure that each injection and the site it was administered is documented separately
· Do not fail to use the appropriate modifier to specify distinct treatments
· Make sure to always confirm the payment policies of each insurer
These are just some major reasons why claims can be rejected. There are other reasons that may have not made this list, which is why many healthcare providers hand this task over to professionals like Holistic Billing Services because they have a good understanding of the process and can ensure that your reimbursements come to you in full.
To get more information on this subject, you can take some time to study this infographic.
Conclusion
Trigger finger injection claims can be confusing and a little error can result in a claims denial. We’ve taken some time in this article to look at these issues, pointing out some common errors and things to take note of.
While we may have provided good information, we know that you may still have some questions. To put your mind at rest, it is best to allow professionals handle this aspect of your business so you can concentrate on your core services to your patients.
