Anesthesia Coding Alert

Question: A patient was diagnosed with carpal tunnel syndrome on both sides. Our pain management physician injected both of the patient's wrists with a local anesthetic and steroid at the same visit. Is there a code for these injections or should I just report 90772? Also, can we report both injections?

Kansas Subscriber

Answer: CPT code 20526 (Injection, therapeutic [e.g., local anesthetic, corticosteroid], carpal tunnel) is a more accurate code for a carpal tunnel injection than 90772 (Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular).

Per the Medicare Physician Fee schedule, 20526 carries a bilateral status indicator of "1," which means the 150 percent payment adjustment for bilateral procedures applies, so this code can be reported to indicate both injections. Since your pain management provider injected both of the patient's wrists, you'll need to report it as a bilateral procedure. You can do this with either modifier 50 (Bilateral procedure) or modifiers LT (Left side) and RT (Right side).

Remember: Many payers request you report bilateral services with modifier 50 appended to the CPT code as a single line item and one unit of service. If however, your payer prefers modifiers LT and RT for bilateral procedures, report the CPT code as two line items (one with LT and one with RT). Check your payer's guidelines to verify its preference.