Orthopedic Coding Alert

Some modifier 50 rules could cause confusion come coding time.

When the orthopedist injects both of a patient's wrists to treat carpal tunnel syndrome, you should just file 20526 with modifier 50 appended and forget about it ... right?

Not so fast: If the physician injects both the patient's wrists to treat CTS, you will typically append modifier 50 (Bilateral procedure) to 20526 (Injection, therapeutic [e.g. local anesthetic, corticosteroid], carpal tunnel), says Kathleen F. Nelson, CPC, orthopedics professional coder at Fletcher Allen Health Care in Burlington, Vt. There are, however, some exceptions.

"This code carries a '1' bilateral status indicator, which means this injection can be reported bilaterally. For many payers this would mean reporting the bilateral injections by appending modifier 50 to the 20526 CPT code and billing one unit of service," says Marvel J Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, of Denver's MJH Consulting.

However: "It is always best to verify the insurance plan's preference for reporting bilateral services, as there are some variances to 'modifier 50 and one unit of service' coding," Hammer continues.

For example, Oregon Medicaid does not accept modifier 50, relays Jacqui Jones, office manager at an orthopedic practice in Klamath Falls, Ore.

If the carrier does not want you to file 20526-50, it will typically accept 20526-LT (Left side [used to identify procedures on the left side of the body) and 20526-RT (Right side [used to identify procedures on the right side of the body]) instead, Nelson says.