april 2014

Answering Your Wrist Coding Questions

Scenario:  This is the second time the patient is being seen for carpal tunnel release.  After the first procedure the patient developed adhesions in the carpal tunnel and now requires a second decompression procedure.  The physician decides to use a local fat pad rotation flap to cover the median nerve and prevent further adhesions.  Would 14020 be reported for the fat pad rotation flap?

Answer:  No, it would not be appropriate to report an adjacent tissue transfer code from the integumentary system for this service.  There is no specific code for fat pad coverage.  However, if the documentation supports a procedure in which the size of the flap and the work performed are significant then the physician may append modifier -22 to the primary CPT code 64721.

Scenario:  The physician states they are performing a carpal tunnel release using a Manos carpal tunnel release system but there is no indication that an endoscope was inserted.  Is this still an endoscopic procedure reported with CPT code 29848?

Answer:  The Manos carpal tunnel release is a “percutaneous” procedure that does not use direct visualization so it is neither an endoscopic (29848) nor an open (64721) procedure.  This service should be reported using CPT code 64999 Unlisted procedure, nervous system.

Scenario:  Patient receives treatment for a distal radial articular fracture and the physician performs a pronator rotation flap.  Can code 15736 for the muscle flap be reported?

Answer:  No, muscle flap code 15736 should not be reported because the procedure is performed through the same incision and considered a component of the fracture care code.

Scenario:  With a distal radial fracture, the physician will often release the brachioradialis so that the fracture fragments can be reduced.  Can code 25290 tenotomy of flexor tendon, forearm and/or wrist be additionally reported?

Answer:  No. Release of the brachioradialis is considered part of the work involved in the fracture reduction – so an additional code for brachioradialis release should not be reported.




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