# Carpal tunnel question



## stevejo (Jun 5, 2008)

Opinion, please, on billing 64721 in conjunction with 64719 using modifier 59 on the 64719.  Many thanks.


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## mbort (Jun 5, 2008)

I'm not sure why you would add the 59 modifier.  64719 does not bundle with the 64721.  If documentation supports both procedures then I would bill both with the second procedure having a 51 modifier if you are billing for the physician.


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## RebeccaWoodward* (Jun 5, 2008)

I agree with Mbort


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## amitjoshi4 (Jun 6, 2008)

One is Release of Median Nerve and other is release of ulner nerve at wrist. Both are different and Physican uses two different incisions to treat this defects. No 59 is required here.


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## stevejo (Jun 6, 2008)

Thank you all for your time and thoughts.  I am very new in this arena  

In this case, both nerves are released through the same incision.  It would seem that 51 makes the most sense.  I'm not sure why the surgeon wants to use 59.


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## coderguy1939 (Jun 7, 2008)

If 64721 and 64719 are not bundled, I'm not sure why you would use either modifier 51 or 59.  If ulnar neuropathy is documented you should be able to bill for that procedure along with 64721 without the use of a modifier.


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## mbort (Jun 9, 2008)

the 51 modifier could be necessary on the 2nd procedure if you are billing for the physician/surgeon.


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## coderguy1939 (Jun 9, 2008)

Does AMA edits require a modifier 51 when 74721 is performed with 64719?  My understanding of modifier 51 is that it is used, when allowed, for the same site, same incision.  These are clearly two separate incisions and it sounds like two separate diagnoses.


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## mbort (Jun 10, 2008)

the 51 is for "multiple procedures" which is needed on the physician side when there is more than one procedure performed.  Are you confusing it with the 59?


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## coderguy1939 (Jun 10, 2008)

Are you saying that you attach a modifier 51 to all surgical procedures performed by the physician at the same op session whether they are bundled or not?  It's been awhile since I've coded for the physician side, but I never attached a mod. 51 or 59 to secondary procedures unless required by AMA edits or CCI.  As an example, AMA requires a mod. 51 attached to 29826 and 29824 when 29827 is performed.  But if the physician performed a tenodesis, 29828 in addition to the other codes, I wouldn't attach any modifier to it because it isn't required by AMA or CCI.


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## mbort (Jun 11, 2008)

yes, on the physician side we add the 51 modifier on the 2nd and all subsequent procedures.  Medicare will automatically add it for us (but to be consistent we do it anyhow).  The commericial carriers require this unless of course the CPT is -51 exempt (Appendix E in the CPT 2008, page 494 of the professional edition).


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## coderguy1939 (Jun 11, 2008)

Thanks for the reply.  I knew that Medicare required the 51 modifier, but not the commercial carriers.


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