# Help with Median Nerve Block



## Melissa Harris CPC (Oct 10, 2014)

Can someone help me with this procedure note Please?

Median Nerve Block


DATE OF PROCEDURE: October 3, 2014

ANESTHESIA: Local/Conscious sedation

PRE-OPERATIVE DIAGNOSIS: 354.0 Carpal Tunnel Syndrome
POST-OPERATIVE DIAGNOSIS: 354.0 Carpal Tunnel Syndrome

INDICATIONS: Right Wrist pain


DESCRIPTION OF PROCEDURE: With written informed consent obtained, risk and benefits are discussed including but not limited to infection. Per patient request 2 mg of Versed was given IM by the nurse.  The patient is brought into the operating room with appropriate monitors and placed sitting upright in a chair with wrist outstretched, with the ventral surface of the wrist extending upward on the procedure room table. The patient was then asked to make a fist, flex at the wrist and the palmaris longus tendon were palpated and marked just medial to the tendon at the skin crease. The area was then prepped  in a sterile fashion. Using one 25 gauge  1 1/2  inch needle where advanced downward towards the carpal tunnel at the marked point until a parathesia or uncomfartableness was felt. At this point after careful aspiration reveals no blood, .5mL of 1% Lidocaine and 9 mg of mg/mL Celestone  was injected into the Right carpal tunnel. The needle was removed, pressure was appiled and the wound was dressed. The patient was removed from the procedure room in stable condtion and brought to the recovery area having tolerated the procedure well.


Is this 64450 or 20526?

Thank you
Melissa Harris, CPC


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## dwaldman (Oct 10, 2014)

Below is from AMA CPT Changes & Assistant 2002. They indicate the use of CPT 20526 is an injection into carpal tunnel (an anatomic space). In the note you provided it states: 

"was injected into the Right carpal tunnel"

I believe the note you provided supports reporting CPT 20526.

Code 20526 has been established to describe the procedural technique required to perform a therapeutic injection into the carpal tunnel (an anatomic space). 

Clinical Example (20526)

A 31-year-old secretary with complaints of numbness involving the 3 radial digits of the right upper extremity. Physical examination reveals a positive Tinel?s sign of the median nerve at the right wrist and decreased sensation of the radial 3 digits in a median nerve distribution. Electrodiagnostic studies reveal a median nerve sensory mononeuropathy at the right wrist consistent with the clinical findings and diagnosis for carpal tunnel syndrome. The patient has failed physical therapy and bracing as well as job modification. She presents now for right carpal canal injection to be followed by physical therapy and post- injection splinting.


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## Melissa Harris CPC (Oct 13, 2014)

Thank you so much!


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