# de Quervains followed by carpal tunnel



## Lisa Bledsoe (May 14, 2010)

A Medicare patient has surgery for de Quervains (CPT 25290 ICD-9 727.05).  Apprx 6-8 weeks post op develops symptoms of carpal tunnel in the same wrist and an EMG with findings "consistent with moderate carpal tunnel syndrome".  Would the visits for the carpal tunnel qualify as E/M with mod -24 as unrelated to the surgery?


----------



## Lisa Bledsoe (May 17, 2010)

*Any/all responses are much appreciated!*



Lisa Curtis said:


> A Medicare patient has surgery for de Quervains (CPT 25290 ICD-9 727.05).  Apprx 6-8 weeks post op develops symptoms of carpal tunnel in the same wrist and an EMG with findings "consistent with moderate carpal tunnel syndrome".  Would the visits for the carpal tunnel qualify as E/M with mod -24 as unrelated to the surgery?



Anyone?


----------



## capricew (May 18, 2010)

lisa curtis said:


> anyone?



first of all dequervains release is 25000  dx 727.04

second, yes you can modify the carpal tunnel with 24  as it is a completely different condition.


----------



## Lisa Bledsoe (May 19, 2010)

CWALDER@PROMEDNV.COM said:


> first of all dequervains release is 25000  dx 727.04
> 
> second, yes you can modify the carpal tunnel with 24  as it is a completely different condition.



Thank you for your response.  However, the procedure performed was not 25000, it was indeed 25290.  The physicians here code their own procedures including dx; he did actually operate on the first extensor tendon and compartment (his op note states de Quervain's tenosynovitis which is incorrect - so I apologize for posting incorrect information).  Anyway, I am cleaning up the denials for the subsequent carpal tunnel dx/visits for which the patient has not yet gone back to surgery.  Since carpal tunnel affects the median nerve rather than the flexor tendon, mod -24 could be applicable.  *The dilema now is this:  previous to surgery only pain was documented in the wrist (per the pt there were no other symptoms ie numbness); then on the post op when carpal tunnel was dx'd (after pt had sudden sharp pain during PT massage), it states that the pt admits to numbness prior to surgery.  I guess since she did not divulge that information to the surgeon initially I should be able to use -24.  Do you agree?*


----------

