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Bilateral Carpal tunnel Injection 51 vs 59

  1. #1
    Default Bilateral Carpal tunnel Injection 51 vs 59
    Medical Coding Books
    If the physician does a bilateral Carpal tunnel injection 20526. Would you use the modifier 51 or 59 and do you know where the guidelines to back that would be?

    Thanks,
    Meagan Dyer CPC
    Meagan Dyer CPC

  2. Default only if...
    59 only if there is one other major procedure on the same day...office visit doesn't count.


    51 if more than 2 other procedures..

  3. #3
    Default
    As with 20610 for bilateral injections, you would use modifiers RT, LT to indicate bilateral injections performed. The guidelines for the modifiers are in the back of the CPT books and also on the CMS website.

  4. #4
    Location
    Nashville AAPC Chapter
    Posts
    937
    Default
    Guidelines state that we are to use the modifier that best describes the scenario, in this case the 20526 would be billed with a modifier 50 showing it was bilateral. Because this CPT code has an MUE edit of 1, the LT/RT, 59 modifier wouldn't work.

    The status indicator for this code is 1 based on the CMS Physician Fee schedule. The instructions for that status indicator states:
    Bilateral surgery rules apply (150%). Use CPT modifier 50 if bilateral. Units = 1. We should not "double" the fee as payment is only made based on the fee schedule anyway and the 2nd CPT code only pays at 50%. Some carriers may require it billed differently, check your carrier, most are following Medicare's guidelines from what I am finding.

    https://www.noridianmedicare.com/je/...escriptors.pdf

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