Second injection

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SpineandWine

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Hello Everyone,

Sometimes patients come in booked for SI joint injection but they may have myofascial pain in thoracic spine for which I think TPI is necessary.

If I do TPI at time of procedure in thoracic spine (not authorized), do we have to 1) charge at same time
What if I just state “TPI was done at end” of my note
I hate access for patients for just TPI and want to get it done with. I don’t care about additional revenue

I want to speed up healthcare but don’t know ramifications of this

How would you navigate this? Providing care without fraud

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for medicare, unless extenuating circumstance (holding anticoagulant), you cannot inject 2 separate locations at the same appointment/day.

have to have separate appointments.

best is to do trigger point injection at the same time you do follow up for SIJ. separate conditions. can still bill insurance (although only like 50%)
 
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for medicare, unless extenuating circumstance (holding anticoagulant), you cannot inject 2 separate locations at the same appointment/day.

have to have separate appointments.

best is to do trigger point injection at the same time you do follow up for SIJ. separate conditions. can still bill insurance (although only like 50%)
As far as I know this is a commonly reported but incorrect rule except for spine regions. There are specific carve outs for epidural and facet injections, where you can do one region at a time, but nothing in the trigger point or SI joint injection guidance to say you can't do that. To be precise, the epidural and facet guidelines don't say you can't do a hip or knee injection, but just that you can't do another spine region at the same time.

I do it when needed but I don't normally submit trigger point codes as I'm just reusing my local needle and the left over local anesthetic. You won't capture the revenue for sure. You could try to do it as with the 51 or 59 modifier, but it may lead to delays and concerns on the collections.
 
As far as I know this is a commonly reported but incorrect rule except for spine regions. There are specific carve outs for epidural and facet injections, where you can do one region at a time, but nothing in the trigger point or SI joint injection guidance to say you can't do that. To be precise, the epidural and facet guidelines don't say you can't do a hip or knee injection, but just that you can't do another spine region at the same time.

I do it when needed but I don't normally submit trigger point codes as I'm just reusing my local needle and the left over local anesthetic. You won't capture the revenue for sure. You could try to do it as with the 51 or 59 modifier, but it may lead to delays and concerns on the collections.
Issue here is that I work in HOPD and nursing charts independently
I’ll have to bill but if issues occur with denial, patient gets stuck with hospital bill (so essentially, won’t be able to offer)
 
a case can be made that it isnt worth your time doing TPIs at all, let alone during your flouro schedule.
 
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Any TPI I do is a freebee add on to another procedure. I don't document it.
 
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Unfortunately, nurses have to document very precisely meds, time, etc.
Don’t want discrepancy
And herein lies the problem. You as a doctor know what you want to do and why. You are doing a tpi as a freebie. Problem is the nurse working for the hopd or asc documents an additional procedure in addition to the esi..this will then become a big issue as there is a discrepancy. It has happened to me at an ASC that I go to. It becomes an issue with consent and documentation and yadda yadda yadda. All for trying to do a solid for the patient. Eventually you feel like not doing it all
 
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what about a GTB and SIJ at same time. I seem to have to do that from time to time
 
Unfortunately, nurses have to document very precisely meds, time, etc.
Don’t want discrepancy
Yeah, they need to document a lot of stuff. It doesn't really change what you do.
- Consent broadly for all other indicated procedures.
- Document you used 10 mL of local for the whole session. Saying you used 8 mL for the trigger and 2 mL for the TFESI isn't really in their wheelhouse but if it is, you can break it down separetely.

Don't make it harder than it is, but do the right thing for the patient. If you told me I'd have to make two trips, pay two set of facility fees, and wait two weeks for that type of silliness, I'd be rather annoyed as a patient, but then again, some patients just like to see me more often. HOPD medicine is just inefficient, but I think you can get it done and let them tell you if there's a problem.
 
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