CTS diagnosis a must for some, but not all, payers on 20526. If you're not familiar with the intricacies of reporting therapeutic injections for carpal tunnel syndrome (CTS) sufferers, you risk miscoding these common procedures. Why? You'll probably need a CTS diagnosis in order to report 20526 (Injection, therapeutic [eg, local anesthetic, corticosteroid], carpal tunnel). There are some payers, however, that don't expressly require a CTS diagnosis for 20526, so you might have to do some research before deciding how to code. Further, you need to prove that the provider made previous attempts to treat the CTS through other means, and master the different ways you can report bilateral CTS shots. So, there's some fact and fiction you'll need to separate when reporting CTS shots. Read on for expert takes on how to make these separations. Myth: You Must Have a CTS Diagnosis to Report 20526 Reality: This is largely, but not entirely, true. For most Medicare (and non-Medicare) providers, the patient must have a CTS diagnosis when you report 20526. Cathy Satkus, CPC, coder at Harvard Family Physicians in Tulsa, Oklahoma, says that Medicare Administrative Contractor (MAC) Novitas only covers the following ICD-10 codes: There might be exceptions to this diagnosis coding rule, but they would be exceptionally rare. "The main diagnosis to use for 20526 would usually be G56.00 to G56.03," says Dreama Sloan-Kelly, MD, CCS, president of Dr. Sloan-Kelly Consulting in Shirley, Massachusetts. "However, I encourage all clients to refer to their local Medicare carrier's LCDs [local coverage determinations]. It is a great resource for ICD-10 diagnosis codes that support medical necessity." For example, Sloan-Kelly points out Noridian's LCD, which doesn't flat-out forbid you from reporting 20526 with a non-CTS diagnosis. In fact, the LCD lists dozens of diagnosis codes that might support medical necessity for the following CPT® codes: This does not mean that you can report 20526 for any of the ICD-10 codes listed in Noridian's coverage determination; it does, however, mean that the payer has not explicitly forbidden 20526 reporting with a non-CTS diagnosis. Best bet: If you're going to file a 20526 claim with a diagnosis other than CTS, tread softly: Check your payer contract, contact a payer rep, and get approval from your supervisor to file this claim. You don't want payers' ears to perk up on these claims; the biggest red flag for 20526 claims is often a lack of a CTS diagnosis. To check out Noridian's LCD on these injections, go to: https://med.noridianmedicare.com/documents/10546/6990981/Injections+-+Tendon, Ligament, Ganglion+Cyst, Tunnel+Syndromes+and+Morton's+Neuroma+LCD/fae75e02-cbbd-4630-a012-e37dd6360472. Myth: You Can Report 20526 Without Prior Treatment Evidence Reality: In order to properly report 20526, you need recorded evidence of failed previous attempts to alleviate the CTS, confirms Sloan-Kelly. Make sure the patient's medical record reflects these attempts. "Essentially, clinical documentation must show that more conservative treatments, such as NSAIDS [nonsteroidal anti-inflammatory drugs], have failed or are contraindicated," she explains. "I always encourage all providers to give an explanation for why it failed - so for instance, in regard to NSAID they should document the patient had very little to no pain relief and describe the pain on a scale of 1 to 10 as always. "If the provider is stating more conservative [CTS] treatments were contraindicated, they again must state why," Sloan-Kelly continues. Some forms of prior treatment that might allow for 20526 payment include: Remember, this is not an exhaustive list. There are other forms of CTS treatment the provider might employ before opting for 20626. No matter the treatment, be sure to note it in the documentation for your CTS patient. Myth: When You Report 20526, You Can't Report Drug Supply Reality: "All providers should bill for the drug supply separately - paying close attention to the dosage to make sure they are coding the correct units," explains Sloan-Kelly. "The most common injectable used for 20526 is J1030 [Injection, methylprednisolone acetate, 40 mg]." Myth: There Is Only 1 Way to Code Bilateral CTS Release Reality: It depends on the payer, according to Satkus. What follows is a list of the most common ways to report bilateral CTS release: Best bet: You'll definitely want to make sure you know how your payer wants you to report bilateral 20526 claims before you file the claim. As evidenced above, there are a lot of permutations to this coding combination.