A trigger point injection is specifically not an IM injection. It is does require a time out because the only way to identify the injection site is to localize it, palpatieit and elicit a twitch response. There is no way to inject a "wrong site" if it is a procedure for "trigger point" injection. If someone simply infiltrating muscle tissue in an area of pain, this is NOT a trigger point injection. "Tender point" injections are NOT the same thing and not reimbursable; dry needling technique requires no medication and can be done by just about anyone (PT, chiropractic, etc.) and also NOT reimbursable.
Local Coverage Determination (cms.gov)
The diagnosis of trigger points requires a detailed history and thorough physical examination. The following clinical symptoms may be present when making the diagnosis:
- History of onset of the painful condition and its presumed cause (e.g., injury or sprain)
- Distribution pattern of pain consistent with the referral pattern of trigger points
- Range of motion restriction
- Muscular deconditioning in the affected area
- Focal tenderness of a trigger point
- Palpable taut band of muscle in which trigger point is located
- Local taut response to snapping palpation
- Reproduction of referred pain pattern upon stimulation of trigger point
The goal is to treat the cause of the pain and not just the symptom of pain.
| Use this page to view details for the Local Coverage Determination for Trigger Point Injections. |
Trigger point and tender point injections are considered INVESTIGATIONAL for all other indications, including the treatment of myofascial pain syndrome not meeting the criteria above, complex regional pain syndrome, abdominal wall pain, and fibromyalgia. Ultrasound guidance of trigger point injections is still considered INVESTIGATIONAL.
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Aleesa M Mobley PhD APN (she/her/hers) Why Pronouns Matter Assistant Professor - Clerkship Director [Pain Management/Substance Use Disorder]
Physical Medicine & Rehabilitation - Neuro Musculoskeletal Institute
Lippincott Procedures: Subject Matter Expert - Wolters Kluwer Publishing
Rowan Medicine Bldg., 42 E. Laurel Rd, Ste 1700, Stratford New Jersey 08084
T: 856-566-7010 | F: 856-566-6956| C: 856-230-1229
mobley@rowan.edu | som.rowan.edu
Learning is not attained by chance, it must be sought for with ardor and attended to with diligence [Abigail Adams (1744 - 1818), 1780].
Original Message:
Sent: 7/20/2023 12:15:00 PM
From: Donna Furlong
Subject: Trigger Point Injections
Recently a question was posed to our team asking if a trigger point injection would be considered a procedure that required a time out. Initially my thought was yes because I was thinking about joint injections but given that a trigger point injection may also be a IM injection, do your teams perform a time out on any or all trigger point injections?
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Donna Furlong MSN NEA-BC RN-BC
RN Clinical Services Senior Director
Banner Medical Group
Phoenix AZ
(719)233-1810
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