april 2015

Carpal Tunnel Coding

Most of us are familiar with the standard open and arthroscopic CPT codes associated with a carpal tunnel release those being:

  • 64721 – Neuroplasty and/or transposition; median nerve at carpal tunnel
  • 29848 – Endoscopy, wrist, surgical, with release of transverse carpal ligament

However, there are still many questions regarding additional procedures that are performed in conjunction with a carpal tunnel release and how should these additional procedures be viewed in relation to CPT coding?

First let’s talk about a new technique for performing CTR that is percutaneous. This utilizes the “Manos” system which is neither an open surgical technique nor visualization using an endoscope. Being that this is a percutaneous approach the recommended reporting would be unlisted nervous system code 64999.

A physician may want to guard against postoperative adhesions so they will perform an ulnar fat pad rotation over the top of the nerve to protect the nerve from scar tissue. There is no CPT code for this type of procedure and the AMA has deemed that if the size of the flap and the amount of work documented by the physician is significant then modifier -22 may be appended to 64721, otherwise there are no changes made to the coding. Please note that it is not appropriate to report a CPT code from the Integumentary system for this service.

Another common scenario is a carpal tunnel release and a flexor tendon tenosynovectomy performed during the same surgical session. Again the coding recommendation issued by the AMA states that modifier -22 may be added to 64721 when the additional amount of work over and above the carpal tunnel release has been documented.

Additionally, if the patient has a separate diagnosis of rheumatoid arthritis or tenosynovitis then CPT code 25115 may be reported for the flexor tenosynovectomy along with 64721 due to the fact that the work associated with the tenosynovectomy is much greater than just performing a carpal tunnel release alone.



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