Verify evidence of previous treatments for successful claims.

If you’re coding for a patient’s carpal tunnel syndrome (CTS) injection, double check for previous, less invasive CTS treatments before getting too far with your claim. If the physician administers an injection during the patient’s initial visit for CTS, you could be facing a denial. Some payers allow CTS injection therapy only when other treatments have failed. Check out these FAQs to make each CTS coding scenario a snap.

Should the Physician Try Other Treatments Before 20526?

Yes. The FP would likely try less invasive treatments before resorting to CTS injection (20526, Injection, therapeutic [e.g. local anesthetic, corticosteroid], carpal tunnel), confirms Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver. These treatments might include, but are not limited to:

• splinting (or bracing)
• medication (non-steroidal anti-inflammatory)
• occupational therapy.

If the patient’s symptoms don’t improve after these attempts, the physician may then proceed with a corticosteroid injection of the carpal tunnel, Hammer says.

Caveat: Check with the payer if you are unsure of its “previous treatment” requirements. Even evidence of previous treatments might not be enough to convince some insurers, says Jacqui Jones, a physician office manager in Klamath Falls, Ore. “We have had a couple of contracted HMOs [health maintenance organizations] impose conservative nonsurgical treatment – even with previous treatment and positive nerve conduction velocities ordered by another physician,” says Jones.

What Diagnoses Support Carpal Tunnel?

Patients that become candidates for CTS injections may present initially with “complaints of progressively worse numbness and tingling (782.0, Disturbance of skin sensation) in their hand and wrist, particularly the thumb, index, and middle finger,” Hammer explains. As the CTS...