# carpal tunnel release and forearm decompression fasciotomy



## jlowder (May 14, 2013)

Please HELP with this 
procedures to be charged
carpal tunnel 64721
decompression fasciotomy 25020
de Quervains release 25000
wrist ganglionectomy 25111

the meat of the op note:
A transverse incision was made cntered over the cyst, which was overlying the first dorsal extensor compartment.  Soft tissue was carried out.  Attention was taken to protect the neurovascular structures.  She had approximately 1cm ganglion cyst arising off the extensor tendon that was excised in the normal fashion.  The first dorsal extensor compartment was incised longitudinally.  There were no weightbearing tendons. 

A longitudinal incision was made over the carpal tunnel.  Soft tissue dissection was carried out.  The transverse carpal liagament was identified and incised longitudinally.  A subcutaneous distal forearm decompression fasciotomy was performed.  The medial nerve was completely decompressed.

Please help me to know what to be and what is bundled.
Thank you


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## joanne71178 (May 17, 2013)

NCCI edits are saying to bill only the  25020 

1. 25020   OK    RVU: 16.10  
Description:
Decompression fasciotomy, forearm and/or wrist, flexor OR extensor compartment; without debridement of nonviable muscle and/or nerve
NCCI Edit Results:
No NCCI Edits for this code. 



 2. 64721   WARNING    RVU: 12.05  
Description:
Neuroplasty and/or transposition; median nerve at carpal tunnel
NCCI Edit Results:
*Edit exists with 25020.  64721 is a Column 2 code. If both 25020 and 64721 are submitted, only 25020 will be paid. - (Modifiers associated with the CCI ARE allowed with this code pair WHEN APPROPRIATE.)*

3.  25000   WARNING    RVU: 9.41  
Description:
Incision, extensor tendon sheath, wrist (eg, deQuervains disease)
NCCI Edit Results:
*Edit exists with 25020.  25000 is a Column 2 code. If both 25020 and 25000 are submitted, only 25020 will be paid. - (Modifiers associated with the CCI ARE allowed with this code pair WHEN APPROPRIATE.)*


 25111   WARNING    RVU: 8.97  
Description:
Excision of ganglion, wrist (dorsal or volar); primary
NCCI Edit Results:
*Edit exists with 64721.  25111 is a Column 2 code. If both 64721 and 25111 are submitted, only 64721 will be paid. - (Modifiers associated with the CCI ARE allowed with this code pair WHEN APPROPRIATE.) *


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## kagal0816@verizon.net (Jun 18, 2013)

*25020 Not represented*

Hi - Based on the information submitted, coding 25020 is inappropriate.  The code requires an "incision that is carried deep to the fascia".  Think about the wording in the note and explain how the incision in this procedure and the procedure is different from the 64721?  The median nerve decompression is the CTR.  Obviously, the surgeon dictated 
"A subcutaneous distal forearm decompression fasciotomy was performed. The medial nerve was completely decompressed." (Distal = located farthest away from a specified reference point - in this case Wrist.  Subcutaenous = below dermis.)  

A true fasciotomy has a very large incision usually from wrist to elbow (on either dorsal or volar surface), but definitely much larger than that required for a 64721 and is usually performed for compartment syndrome, or crush or burn injuries.  Using this code for a median nerve decompression (64721) is disingenuous at best, and could be construed as "up-coding".  Be careful!  

Karen, CPC, COSC


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