Local Coverage Article Response to Comments

Response to Comments: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma


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Article ID
Article Title
Response to Comments: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma
Article Type
Response to Comments
Original Effective Date
Retirement Date
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Article Guidance

Article Text
Noridian's response to provider recommendations for comment period ending 12/15/2016.

Response To Comments

1A comment was received that injections were part of conservative management and there should not be a requirement to use non-steroidal anti-inflammatory drugs or other measures before injections are considered.The Contractor agrees and has reworded the narrative in the policy.
2Comments were received to change the CPT code delineated in the policy for the billing of therapeutic injection(s) to the tarsal tunnel(s). The Contractor has changed the CPT code to be billed for the injection of the tarsal tunnel(s) to 28899. Although there is no CPT code for this service, the coding convention is to use CPT code 28899, with the notation “tarsal tunnel injection” in the narrative field. CPT code 20526 could not be used because it is specific for carpal tunnel injection and because the use of an incorrect code could generate claims issues with secondary insurers.
3Several comments were received regarding the ICD-10 codes in the policy.Several of the requested additions really pertained to other types of injections. Injection of bursae and synovium of joints are associated with injection of joint codes. Injections of joints are also part of another CPT code. The Contractor received no literature supporting the use of injection for the treatment of complete rupture of tendons and did not add these codes. Vague muscle locations seemed best assigned to the CPT codes for trigger point injections. Nonetheless, a few additional ICD 10 codes were added, such as those for palmer fascial fibromatosis, bilateral carpal and tarsal tunnel syndromes and incomplete tears of the rotator cuff of the right and left shoulders.
4Comments were received about the clarity of the paragraph on limits of the number of injections given.The language with regard to this section of the policy has been modified to be more clear.
5A question was submitted about the 30% rule language at the bottom of the policy.The Contractor is required to compare the number of CPT codes used in a policy to the applicable section of the CPT manual. If more than 30% of the codes in the policy come from that section of CPT, only abbreviated descriptors of the CPT codes may appear in the policy rather than full descriptors.

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  • injection
  • tendon
  • ligament
  • L34076