Orthopedic Coding Alert

Question: Our physician administered several injections to several nerves in a patient's wrist to treat chronic wrist pain due to an old injury. How do I report what he described as "median nerve injection"?

Montana Subscriber

Answer: You basically have two codes to select between, based on the anatomic site and nerves injected: 64450 (Injection, anesthetic agent; other peripheral nerve or branch) or 20526 (Injection, therapeutic [e.g., local anesthetic, corticosteroid], carpal tunnel).

Here's the difference between the two codes:

• In 64450, the physician injects a local anesthetic into the branch of the nerve being anesthetized for pain control or blockage. You use 64450 for nerve blocks of nerves that don't have a specific CPT code listed in the section of somatic nerve injections.

• With 20526, the physician administers a single therapeutic injection of corticosteroid and/or anesthetic at the wrist crease into the carpal tunnel. The injection treats a neuropathy of the median nerve as it passes through the carpal tunnel and helps provide temporary relief of carpal tunnel syndrome symptoms.