Stupid CMS Codes by Michael Gorback MD
It’s early so we may have some other good candidates for Stupidest Coding of the Year but here goes: Novitas, the CMS carrier for TX, only allows the following ICD-9 codes for trigger point injections:
723.1 Cervicalgia (translation: neck pain that [1] I couldn’t figure out or [2] didn’t take the time to figure out)
723.9 Unspecified musculoskeletal disorders and symptoms referable to neck (translation: cervicalgia)
724.1 Pain in Thoracic spine (translation: cervicalgia in the thoracic spine)
724.2 Lumbago (translation: cervicalgia in the lumbar spine. Does ANYONE who graduated medical school after 1940 use that term?)
726.19 Other unspecified disorders of bursae and tendons in shoulder region (When did bursae and tendons become trigger point generators?)
729.1 Myalgia and myositis unspecified (translation: cervicalgia of anything, or maybe polymyositis, Guillian-Barre, or post-polio syndrome)
Arms, legs, hips – who knows? I guess they go into 729.1
I’m sure that ICD-10 will fix this and we can code for “Unspecified musculoskeletal disorders and symptoms referable to neck due to being hit by falling spacecraft parts, initial encounter”
Seems appropriate to me. doesn’t it reflect the lack of evidence for trigger point injections? Perhaps refer to a chiropractor? or stop doing trigger point injections?
I’ve always liked that the ICD-9 code for low-back pain was linked to “lumbago.” There’s something quaint and historic about the word and it does really mean pain in the low back. Low-back pain in the ICD-10 (M54.5) is just called low-back pain. Lumbago is now paired up with sciatica for M54.4-. The logic of all this escapes me and why can’t there just be a code for “Trigger-point injection deficiency?”