Orthopedic Coding Alert

Here are the exceptions.

If both of a patient’s wrists require injections to treat carpet tunnel syndrome (CTS), then limiting yourself to modifier 50 (Bilateral procedure) could be a big mistake. It’s true that this is your typical go-to modifier, but there are 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, ACS-PM, CPCO, owner of MJH Consulting in Denver, Co.

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.

If the carrier does not want you to file 20526-50 (Injection, therapeutic [e.g. local anesthetic, corticosteroid], carpal tunnel; Bilateral procedure), 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.