# Tenosynovectomy and Carpal Tunnel Release



## redmoore

Hello- 

I'm very new to ASC billing and I have never coded carpal tunnel procedures.
The provider is stating procedure performed:
1. Flexor Tenosynovectomy, right wrist
2. Carpal tunnel release, right wrist

Curvilinear skin incision on the volar aspect of the right wrist was made and the subcutaneous tissue was incised.  Proximally, fasciotomy was done.  Distally, thick carpal ligaments were released in the line of the fourth finger.  The branches of the median nerve were protected.  Complete hemostasis was confirmed with electrocautery.  Significant amout of hypertrophic flexor tenosynovitis was noted, and each and individual flexor tendon was identified and flexor tenosynovectomy was done.  Significant additional decompression accomplished.  

Please help!   I've come up with 64721, 26145.  Is the fasciotomy coded?

Thank you,


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## SS62

hi, 

I bill this all the time.  I checked the edits for these two and there are no bundling issues.  No bill for the fasciotomy. Hope this helps!


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## redmoore

thank you!!


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## Yoli

ncoder2 said:


> Hello-
> 
> I'm very new to ASC billing and I have never coded carpal tunnel procedures.
> The provider is stating procedure performed:
> 1. Flexor Tenosynovectomy, right wrist
> 2. Carpal tunnel release, right wrist
> 
> Curvilinear skin incision on the volar aspect of the right wrist was made and the subcutaneous tissue was incised.  Proximally, fasciotomy was done.  Distally, thick carpal ligaments were released in the line of the fourth finger.  The branches of the median nerve were protected.  Complete hemostasis was confirmed with electrocautery.  Significant amout of hypertrophic flexor tenosynovitis was noted, and each and individual flexor tendon was identified and flexor tenosynovectomy was done.  Significant additional decompression accomplished.
> 
> Please help!   I've come up with 64721, 26145.  Is the fasciotomy coded?
> 
> Thank you,




My understanding on the Tenosynovectomy performed at the wrist incision is coded 25116. the surgeon explained to me that he approaches those flexor tendons from the wrist without extending the excision into the palmer. Then it is a 25116. But if he has to extend the excision to the palmer then it is the 26145. You might want to look at the documentation to see the approach on that.
Yoli


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## SS62

Oops,  I suppose I zoomed in on the _"thick carpal ligaments were released in the line of the fourth finger" _  this has always confused me.  However, in this case you would code 25115 flexors vs. 25116 extensors. thanks


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## mbort

and 25115 does bundle with 64721 the last time I checked


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