# CPC Study Guide



## reming55 (Jun 20, 2011)

Hi - This is the Scenario:
Preop DX:  Left carpal tunnel syndrome
Postop DX: Same
Anesthesia: Bier Block
Procedure Performed: Left carpal tunnel release, median epineurolysis
Findings:  Median nerve was adherent but no masses.

Indications: Pt has documented CTS based on EMG and desires elective release.
Procedure:  The pt was taken to the OR, positioned supine on the table and anesthesia was admnistered. The limb was prepped & draped in sterile fashion, elevated using compressive bandage & the tourniquet was inflated to 225mmhg. The gauge was tested for oscillation. Local infiltration w 1% Xylocaine into the medial & ulnar positions were performed.

An incision was made dep thru the subcu tissues. Bleeding points were electrocoagulated using bipolar cautery and skin edges were handled atraumatically. Palmar fascia was identified & incised and the transverse carpal ligament was exposed. A wide release was achieved by opening its ulnar most aspect and carrying the dissection distally to crossing the ulnar neurovascular bundle & proximally under vision in the antebrachial fascia of the forearm.   The median nerve was adherent and an epiurotomy was carried out. 
( I think that was a typo and they meant to say EPINEUROTOMY ).  .....sponge, instrument and needle counts were correct.   

Now the correct codes given were:  64721 and 354.0.    I thought 64727 should be assigned because of the epineurolysis -  Any thoughts on that ?  Thank you in advance !
Noelle


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## surgonc87 (Jun 20, 2011)

median epineurolysis is included in CPT 64721. The only time you would use the add on code + 46727 is if there is internal neurolysis, requiring use of operating microscope as code discribes.

I know these questions can be tricky.
Ms


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