april 2017

Wrist Procedures

Here are a number of coding tips that are based off of information that can be found in CPT Assistant. Keep in mind that these same guidelines may not apply to Medicare claims and individual carriers may have specific payment policies that differ from the information below.

1. When a distal radial fracture repair is performed, you can additionally report an open or percutaneous repair of the ulnar styloid but you cannot additionally report a closed treatment of the ulnar styloid.

2. A brachioradialis tendon release is considered a component of the distal radial fracture repair and is not additionally reported.

3. A pronator muscle rotation flap is not reported with a distal radial fracture repair when performed through the same incision as the fracture repair.

4. There are 2 interosseous nerves – the anterior and posterior. The correct CPT code to report for transection of these nerves during wrist surgery would be 64772 and this code would be reported twice if both the anterior and posterior interosseous nerves are transected.

5. Per AMA guidelines if internal fixation is removed to treat nonunion of a fracture you can report 20680 and the nonunion fracture repair code. Per CCI Edit guidelines, if removal of the internal fixation is performed to accomplish a more extensive procedure the hardware removal code 20680 cannot be reported.

6. When replacing internal fixation (broken or loosened screw) – you can report 20680 for removal of the implant, but there isn’t a CPT code for inserting a new screw so you would have to use an unlisted CPT code based on the anatomical site.

7. CPT code 25118 Synovectomy, extensor tendon sheath, wrist, single compartment may be reported one time for each compartment that is treated. Another example of when 25118 would be reported is when the patient has De Quervain’s and a synovectomy of the first dorsal compartment is performed.

8. During carpal tunnel release, a fat pad rotation flap is not additionally reported. The physician may append modifier -22 to 64721 if the documentation reflects the size, amount of work and additional time it took to create the flap. It is not appropriate to report an integumentary system code for this type of flap.

9. Once a carpal tunnel release has been performed and the physician goes on to wrap the median nerve you should report 64721 and 64999 (unlisted nervous system procedure) for the nerve wrapping.

10. When performing a carpal tunnel release along with a flexor tenosynovectomy and you have a separate diagnosis such as tenosynovitis or rheumatoid arthritis it would be appropriate to report both 64721 and 25115 based on the fact that removing the tenosynovitis exceeds the work normally associated with just a carpal tunnel release. However, for Medicare patients 64721 bundles into 25115 so you would only report the flexor tenosynovectomy code 25115.


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