What Is the Best Way to Code Bilateral 64721

From conservative to invasive treatments, understand what codes are covered.

Carpal tunnel syndrome is diagnosed when there is pressure on the median nerve in the wrist. Some symptoms include pain, numbness, tingling, and weakness in the mitt. The dr. may order physical therapy, or prescribe a wrist brace or nonsteroidal anti-inflammatory drugs (NSAID). To reach coverage and payment, the provider should certificate the bourgeois treatment provided, along with the patient's response to these methods.

Injection

Following more bourgeois treatments, an injection performed in the wrist with corticosteroids and/or anesthetics can provide temporary relief of the symptoms. The injection is reported with 20526 Injection, therapeutic (eg, local coldhearted corticosteroid), carpal tunnel. If you lot perform this service in an office setting and purchase the medication, don't forget to code for the corticosteroid using the advisable HCPCS Level 2 code (In a infirmary or outpatient setting, the facility codes for the drug).
CPT® 20526 is a unilateral lawmaking. To bill bilateral injections, either append modifier 50 Bilateral process or study the code on two lines and append modifiers RT Correct side and LT Left side. Know the insurance carrier's preference to determine if you should append modifier l or anatomical modifiers RT/LT.
Note: Novitas Solutions has a local coverage policy for CPT® 20526. Under the utilization guidelines it states, "More than 3 injections per anatomic site in a six month period will be denied. More than two anatomic sites injected at any ane session will be denied." It's important to check these guidelines with the different payers.

Surgery

A more than productive intervention is for the physician to perform a release of the ligament, through either an endoscopic or open approach.

Endoscopic Approach

The endoscope is placed into the wrist through a small incision in the wrist joint. The scope is used to identify the carpal ligament, which is divided to relieve pressure level on the median nerve and tendons. An endoscopic carpal tunnel release is reported with CPT® lawmaking 29848 Endoscopy, wrist, surgical, with release of transverse carpal ligament.

Open Approach

In an open approach, an incision is made over the carpal tunnel. The ligament is divided to release force per unit area on the median nerve, or the nervus may be relocated to salvage the pressure. An endoscope is not used in this process. The CPT® code to study this procedure is 64721 Neuroplasty and/or transposition; median nerve at carpal tunnel.
Both endoscopic and open carpal tunnel release surgeries are unilateral codes. To report bilateral injections, either suspend modifier 50 to the single code or bill the code on 2 lines and suspend modifiers RT and LT, depending on the insurance carrier's preference.

When Endoscopy Turns Open

The National Right Coding Initiative Policy Manual for Medicare Services, updated Jan. 1, states:
CPT code 29848 describes endoscopic release of the transverse carpal ligament of the wrist. CPT code 64721 describes a neuroplasty and/or transposition of the median nervus at the carpal tunnel and includes open release of the transverse carpal ligament. The procedure coded every bit CPT code 64721 includes the procedure coded every bit CPT code 29848 when performed on the same wrist at the same patient encounter. If an endoscopic procedure is converted to an open procedure, only the open procedure may be reported.

Documentation

Whether the patient is having an injection or surgery, consent is needed. Consent may be verbal for an injection given in a physician function, but must exist in writing for surgery in a hospital or other outpatient setting. Most hospitals require consent forms to be filled out by the provider and signed by both the provider and the patient. For verbal consent, the provider must document that consent was obtained by the patient or the patient'due south guardian.
Additionally, the md should document the prep, the location, the needle, aspiration (if performed), drug, dosage, and how the patient tolerated the procedure.

ICD-10-CM

ICD-x-CM breaks down carpal tunnel syndrome based on laterality. The codes are in Affiliate half dozen, Diseases of the Nervous Organization:
G56.00 Carpal tunnel syndrome, unspecified upper limb
G56.01 Carpal tunnel syndrome, correct upper limb
G56.02 Carpal tunnel syndrome, left upper limb
G56.03 Carpal tunnel syndrome, bilateral upper limb
Postal service-op
Carpal tunnel surgery has a 90-day global period. Global periods tin be constitute in the Physician Fee Schedule. Whatever evaluation and direction (E/M) visits to the surgeon or the surgeon's associates related to the carpal tunnel surgery are inclusive in the reimbursement for the surgery and cannot be separately reported.

Improver Procedures

If the physician performs internal neurolysis (such equally a pain cake) using an operating microscope during a carpal tunnel release using an open approach, report add-on lawmaking 64727 Internal neurolysis, requiring use of operating microscope (Listing separately in addition to for neuroplasty) (Neuroplasty includes external neurolysis) in add-on to 64721. A parenthetical annotation states, "Do not written report code 69990 in add-on to code 64727."
Check with the insurance carrier to verify if they require modifier 51 Multiple procedures when billing bilateral procedures on ii lines using the anatomic modifiers RT/LT.

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Resources
CMS LCD look-upward
Physician Fee Schedule Await-up Tool (global flow, bilateral modifier)

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Doc Coding Auditor, Educator & Consultant at Medkoder

Angela Clements, CPC, CPMA, CEMC, CGSC, COSC, AAPC Approved Teacher, has over 20 years of feel in the healthcare industry. She served equally Region v representative on AAPC'south National Advisory Board from 2013 to 2015 and as the member relations officer from 2015 to 2018. Clements has extensive experience in multispecialty coding, documentation, and auditing. She's as well a frequent speaker at local medical managers' meetings, every bit well every bit other AAPC local chapters in her region.

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Source: https://www.aapc.com/blog/38097-relieve-coding-pressures-of-carpal-tunnel-syndrome/

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