Trigger Point
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Anatomy
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Diagnosis/ Condition
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Surgical treatment
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How to lead CPT code
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CPT code selection criteria
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Live chart sample
1.Anatomy
A trigger point is a sensitive area of tight, painful muscle tissue, often referred to as a muscle knot. These points form when a muscle becomes overly tight or stressed, leading to a small, localized spasm within the muscle fibres
2.Disease and Condition
Trigger Point of Muscle and Finger
3.Surgical treatment
1. Trigger Point Injection
Trigger point injection (TPI) is a medical procedure used to treat painful muscle knots or trigger points that do not relax, often causing localized or referred pain. It involves injecting a medication directly into the trigger point to reduce pain and alleviate muscle tension.
2. Trigger Point release surgery for Finger
Involves cutting or releasing the tight muscle bands or fascia associated with the trigger point
4.How to lead correct CPT Code
In CPT book ,
Trigger Finger Repair-26055
Trigger Point Injection-20552,20553,20560,20561
5.Code selection criteria for Trigger Point
The code selection criteria for Trigger Point is based on
1.No of muscle in which injection is given
2.With/Without use of therapeutic agent such as cortisteroid substance
3.Release of Trigger Finger
Coding Tips
Trigger point codes are grouped to reflect the total number of muscles treated, not how many injections the provider performs. When the provider treats one or two muscles with injections, regardless of the number of injections, report 20552, Injections, single or multiple trigger points, one or two muscles. When the provider performs trigger points on three or more muscles, report 20553, Injections, single or multiple trigger points, three or more muscles.
Live Sample Chart 1
A patient presents with neck and shoulder pain. The provider performs six injections on the patient's trapezius muscle and three on the levator scapulae.
What will be correct CPT ?
Answer 20552: Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) Trigger point injection, or TPI, is a medical procedure that involves injecting an anesthetic or corticosteroid substance to relieve a trigger point, which is a painful area or knot in a muscle.
Live Sample Chart 2
A patient complains of severe lower back pain. The provider performs a single TPI to the patient's quadratus lumborum, and two injections each to the gluteus maximus and gluteus medius
What will be correct CPT ?
Answer 20553: Injection(s); single or multiple trigger point(s), 3 or more muscles. Trigger point injection, or TPI, is a medical procedure in which the provider injects an anesthetic or corticosteroid substance into three or more muscles to relieve painful areas or knots in muscles that form when muscles don’t relax.
Live Sample Chart 3
Preoperative diagnosis : Trigger digit ring finger (Left)
Postoperative diagnosis : Trigger digit ring finger (Left)
PROCEDURE: Trigger finger release.
PROCEDURE IN DETAIL: After administering appropriate antibiotics and MAC anesthesia, the upper extremity was prepped and draped in the usual standard fashion. The arm was exsanguinated with Esmarch, and the tourniquet inflated to 250 mmHg.
A longitudinal incision was made over the digit's A1 pulley. Dissection was carried down to the flexor sheath with care taken to identify and protect the neurovascular bundles. The sheath was opened under direct vision with a scalpel, and then a scissor was used to release it under direct vision from the proximal extent of the A1 pulley to just proximal to the proximal digital crease. Meticulous hemostasis was maintained with bipolar electrocautery.
The tendons were identified and atraumatically pulled to ensure that no triggering remained. The patient then actively moved the digit, and no triggering was noted.
After irrigating out the wound with copious amounts of sterile saline, the skin was closed with 5-0 nylon simple interrupted sutures.
Answer 26055-T4 : Tendon sheath incision (eg, for trigger finger) Trigger finger, or stenosing tenosynovitis, is when a finger remains in a bent position. It is painful to open or close the finger. A swollen tendon or formation of knots or nodules in the tendon may cause trigger finger, as well as trauma or medical conditions like rheumatoid arthritis.
Live Sample Chart 4
PREOPERATIVE DIAGNOSIS: Right trigger thumb.
POSTOPERATIVE DIAGNOSIS: Right trigger thumb.
OPERATIONS PERFORMED: Trigger thumb release.
ANESTHESIA: Monitored anesthesia care with regional anesthesia applied by surgeon with local.
COMPLICATIONS: None.
DESCRIPTION OF PROCEDURE: With the patient under adequate anesthesia, the upper extremity was prepped and draped in a sterile manner. The arm was exsanguinated. The tourniquet was elevated to 290 mm/Hg. Attention was turned to the palmar surface of the thumb where a transverse incision was made over the A-1 pulley. Blunt dissection exposed radial and ulnar neurovascular bundles which were retracted out of the operative field. The A-1 pulley was identified. The A-1 pulley was divided along its radial border, completely freeing the stenosing tenosynovitis (trigger release). The skin was allowed to resume its normal anatomical position and was closed with interrupted sutures. Sterile dressings were then applied to all wounds. The tourniquet was deflated, and the patient was returned to the Holding Area in satisfactory condition, having tolerated the procedure well.
Answer 26055-T5 : Tendon sheath incision (eg, for trigger finger) Trigger finger, or stenosing tenosynovitis, is when a finger remains in a bent position. It is painful to open or close the finger. A swollen tendon or formation of knots or nodules in the tendon may cause trigger finger, as well as trauma or medical conditions like rheumatoid arthritis.
Live Sample Chart 5
A 38-year-old female presents with diffuse right-shoulder myofascial pain.
Physician or other qualified health care professional palpates and locates the trigger points to be needled. Secure the first muscle between the fingers of the nonneedling hand. Insert sterile, single-use, solid-filament needles, varying from 32 to 38 gauge and 25 to 100 mm in length, at various depths and angles to achieve the desired result of releasing tight tissue, improving microcirculation, and removing neuronoxious chemicals. Make interactive reassessments throughout the procedure, noting needle fibrillation, local twitch response, and/or reproduction of symptoms, including but not limited to achiness, burning, and electricity. Repeat this process for each additional muscle to be treated. Withdraw the needles and apply pressure (hemostasis) directly to the skin over the needle-insertion site.
Answer 20560 : Needle insertion(s) without injection(s); 1 or 2 muscle(s). The provider, typically a physical therapist, inserts a needle, without medication, into a trigger point of 1 or 2 muscles to help relieve pain.
Live Sample Chart 6
A 48-year-old Male presents with neck pain, muscle-tension headaches, and diffuse right-shoulder myofascial pain.The physician or other qualified health care professional palpates and locates the trigger points to be needled. Secure the first muscle between the fingers of the nonneedling hand. Insert sterile, single-use, solid-filament needles, varying from 32 to 38 gauge and 25 to 100 mm in length, at various depths and angles to achieve the desired result of releasing tight tissue, improving microcirculation, and removing neuronoxious chemicals. Make interactive reassessments throughout the procedure, noting needle fibrillation, local twitch response, and/or reproduction of symptoms, including but not limited to achiness, burning, and electricity. Repeat this process for each additional muscle to be treated. Withdraw the needles and apply pressure (hemostasis) directly to the skin over the needle-insertion site.