Anesthesia 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 to  the wrist crease between the tendons of the radial flexor and the long palmar muscles of the forearm. The injection blocks the radial nerve as it passes through the carpal tunnel and helps provide temporary relief of carpal tunnel syndrome symptoms.