Billing for tendon sheath injections? You should apply the correct code to receive complete reimbursement on time. Injecting medicine is often the ideal treatment for reducing inflammation and pain. That’s why healthcare providers, including orthopedic surgeons, usually administer injections directly into the tendon sheath to address conditions like tenosynovitis.
CPT code 20550 covers this procedure. Surprisingly (or perhaps not), many providers miscode this service for various reasons. The most common of them being? Unfamiliarity with CPT code 20550! Today, we will analyze this code in detail to help you avoid the same fate and persistent denial problem.
CPT Code 20550 – Description
So, what exactly is this code about? CPT code 20550 refers to a popular musculoskeletal system procedure. As we hinted in the intro, it specifically refers to a therapeutic tendon sheath injection. The primary purpose of this injection? To relieve pain and inflammation in the thin layer of tissue surrounding tendons.
In short, this injection, composed of a steroid, promotes healing in cases of tendonitis or ligament injuries. Simply put, healthcare providers, such as primary care physicians or orthopedic surgeons, use CPT code 20550 to report an injection into a specific:
- tendon sheath,
- ligament or,
- aponeurosis (plantar fascia).
Scenarios Where CPT Code 20550 is Applicable
Not sure when to apply this code for tendon sheath injections? Here are three scenarios where CPT code 20550 is applicable:
Injection to Reduce Plantar Fasciitis Pain
Did you know that around 1 in 10 people experience plantar fascia inflammation (plantar fasciitis) at some point in life? This condition is extremely common, affecting around 2 million Americans each year. While healthcare providers usually recommend conservative treatments to manage it at first, they move on to injections when they don’t work.
So, for our first example, let’s consider a similar case. Suppose a 34-year-old professional dancer starts experiencing sharp pain in her right heel while dancing or walking. She visits an orthopedist for treatment. After examining her foot, the specialist recommends rest, icing, and anti-inflammatory drugs.
However, these initial interventions are ineffective. Therefore, the orthopedist eventually has to inject a corticosteroid into the patient’s plantar fascia to reduce inflammation and pain. He reports this service using CPT code 20550.
Tendon Sheath Injection to Manage De Quervain’s Tenosynovitis
A thin layer of connective tissue sheet protects our tendons. But just like any part of the body, it can also become inflamed due to overuse. This condition is called tenosynovitis, and de Quervain’s tendinosis is one of its most common forms.
So, for our next example, consider a 37-year-old woman with rheumatoid arthritis. She experiences pain and swelling on the thumb side of her right wrist, making it difficult to grasp objects. She visits her physician for evaluation. After examining her thumb and wrist, the provider diagnoses her with De Quervain’s tendinosis and initially recommends non-steroidal anti-inflammatory drugs (NSAIDs) and a wrist splint.
However, these conservative treatments fail to provide relief. Therefore, the physician administers a corticosteroid injection into the affected tendon sheath to reduce inflammation and improve mobility. His billing team then bills for this procedure using CPT code 20550.
Tendon Sheath Injection to Manage Swimmer’s Shoulder
Did you know that around 30% of healthcare visits for neuromuscular problems are related to tendons? This includes tendonitis, often due to sports-related activities. Let’s consider a type of this condition for our final scenario.
Suppose a 23-year-old competitive swimmer visits an orthopedic surgeon due to pain and stiffness in his right shoulder, especially during backstroke. The specialist notes his symptoms and confirms the Swimmer’s Shoulder after a physical examination and imaging studies. Just like any other specialist, he also recommends conservative treatments at first.
But when they fail, he injects a corticosteroid directly into the affected tendon sheath. The orthopedic surgeon then files a claim for this service using CPT code 20550.
Applicable Modifiers for CPT Code 20550
Still receiving denials for CPT 20550 after doing everything right? Modifiers might be the missing piece in your clean claims! Here are a few modifiers you can use with CPT code 20550:
FA, F1 to F9 Modifiers
How would payers know where you injected the medicine? To avoid this mistake, use the following modifiers to specify the exact finger on which you performed a tendon sheath injection.
| F-Series Modifiers | Location |
|---|---|
| FA | Thumb of the left hand |
| F1 | Second digit of the left hand (index finger) |
| F2 | Third digit of the left hand (middle finger) |
| F3 | Fourth digit of the left hand (ring finger) |
| F4 | Fifth digit of the left hand (little finger) |
| F5 | Thumb of the right hand |
| F6 | Second digit of the right hand (index finger) |
| F7 | Third digit of the right hand (middle finger) |
| F8 | Fourth digit of the right hand (ring finger) |
| F9 | Fifth digit of the right hand (little finger) |
LT Modifier
Did you inject the medicine on the left side of the body? For example, if you have injected into the left wrist’s synovial lining (tendon sheath), apply modifier LT to CPT code 20550.
RT Modifier
On the other hand, if you administered the tendon sheath injection on the right side of the body, append modifier RT to code 20550.
Modifier 59
Want to receive separate payment for CPT code 20550 when you have performed multiple services on the same patient? Use modifier 59 if the tendon sheath injection was distinct from other services you performed on the same date.
Modifier XS
If you injected the medication at a different anatomical site from other services, apply modifier XS to CPT 20550.
CPT Code 20550 – Billing & Reimbursement Guidelines
Want to bill tendon sheath injections properly? Follow these simple billing and reimbursement guidelines for CPT code 20550:
Use 20550 for a Tendon Sheath Injection
It is quite easy to confuse this code with CPT code 20551. The reason? There is only a minor difference in their description. Keep in mind that CPT code 20550 only covers an injection into a single tendon sheath, mostly for addressing common conditions like plantar fasciitis.
On the other hand, CPT code 20551 covers the administration of an injection directly into a tendon’s insertion or origin point. Therefore, use code 20550 only when administering the medication in the fibrous sheath (tendon sheath) and not in a tendon origin.
Justify Medical Necessity for 20550 with Proper Documentation
Remember, payers only cover medically necessary injections. Therefore, your clinical notes should include all the elements that led to the diagnosis and decision to use this code. These include:
- Symptoms and current condition
- Appropriate diagnostic code supporting the need for tendon sheath injection (M72.2, M65.4, etc.)
- The specific site where you have administered the medication
- Medication used (corticosteroid or any other medicine)
Specify the Exact Injection Location with Modifiers
You know how essential modifiers are for providing context. In this case, always use appropriate anatomical modifiers with CPT code 20550 to avoid denials. If you have administered multiple injections on the same day, use modifiers 76 or 77.
Bill 20550 Per Injection Site
Always report CPT code 20550 for a single injection per anatomical site, not per dose. If you administered tendon sheath injections at multiple anatomical sites, bill each injection on a separate line using appropriate modifiers (59 or XS).
Confirm Payer Policy
Make it a habit to verify each payer’s coverage requirements before filing a claim for CPT code 20550. For example, Medicare requires proper justification if you administer more than three tendon sheath injections on the same site or local area within six months.
Summary
Confidently put what you have learned about CPT code 20550 into practice! This musculoskeletal system procedural code is quite simple. However, healthcare providers make small documentation and modifier mistakes, which lead to delays and denials.
To summarize, CPT 20550 refers to a single tendon sheath injection. Healthcare providers administer this medication to reduce pain and discomfort caused by plantar fasciitis or other conditions. The secret to its successful billing lies in how well you have followed the reimbursement guidelines. We have highlighted all the important billing tips, including three specific scenarios, so you can understand CPT code 20550’s correct application. But if there is still some confusion, consider outsourcing your coding to a company offering orthopedic billing services. This step will help you get the support you need for timely reimbursements.
