Billing and Coding: Pain Management - injection of tendon sheaths, ligaments, bursa, and ganglion cysts

Injections into tendon sheaths, ligaments, bursae, and ganglion cysts are covered when medically necessary for diagnostic or therapeutic purposes and fully supported by medical record documentation. Diagnostic injections are limited to a maximum of two (spaced >=1 week, preferably 2), and therapeutic injections require an adequate diagnostic response (>=75% initial relief and sustained >=50% for six weeks) and must be spaced at least two months apart, with no more than four injections per patient per year anticipated for most patients. Coding and billing requirements (ICD-10 on claim, HCPCS drug reporting, appropriate modifiers such as 59 and RT/LT, and adherence to NCCI/OPPS edits) and detailed procedure documentation are required for coverage.

"Injections of tendon sheaths, ligaments, bursae, or ganglion cysts are covered when medically necessary for diagnostic or therapeutic purposes and when supported by the patient's medical record doc..."