# 64721,64718,64719 - Can all of these be billed at one time



## ASC CODER (Aug 2, 2010)

Can all of these be billed at one time. Doc has stated in op report that he did these but pt has Medicare. Does any one know of bundeling issues??

Thanks


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## kathydaniel (Aug 2, 2010)

I don't see any bundling issues per CCI.


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## RebeccaWoodward* (Aug 2, 2010)

Only thing I want to add is that the AAOS states not to report 64719 if this is an exploration/incidental release of the ulnar nerve.  You can report 64719 for the neuroplasty of the ulnar nerve for documented ulnar neuropathy.


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## ASC CODER (Aug 2, 2010)

Thank you
 then the surgical procedure commenced using a #15 blade scalpel to make a skin incision starting at the mid point between the medial epicondyle and the olecranon process overlying the cubital tunnel. The incision then progressed proximally up the posteromedial aspect of the upper arm, and distally along the ulnar medial aspect of the proximal forearm. The incision was extended proximally, approximately 8 cm proximal to the medial epicondyle at the location of the arcade of Struthers, and the distal incision extended approximately 3 to 4 cm distal to the medial epicondyle in order to expose the ulnar nerve as it dives between the two heads of the flexor carpi ulnaris. Initially, subcutaneous fat was divided by spreading with a small pair of blunt tip Metzenbaum scissors until the cubital tunnel was identified and exposed. The cubital tunnel was then incised, taking care to protect the ulnar nerve, and then the dissection continued proximally, teasing 
the ulnar nerve from the surrounding soft tissues by spreading the tips of the blunt tip small Metzenbaum scissors. Again, it was freed proximally all the way up and including the arcade of Struthers, in order to address any possible nerve compression here.

Once the proximal extend of the nerve was completely freed, it was traced distally until it then passed between the two heads of the flexor carpi ulnaris. The small fascial band here was divided to insure that the nerve was not compressed here as well.

I then transposed the ulnar nerve anterior to the medial epicondyle, placing it in a pocket that was made between the subcutaneous fat and the periosteum overlying the anteromedial epicondyle. Simple 3-0 Vicryl sutures were placed, tacking the periosteum of the medial epicondyle to the subcutaneous fat layer in order to create a pocket anterior to the medial epicondyle for the nerve to reside. In this manner, the nerve was blocked from subluxating back posterior to the medial epicondyle. Three sutures were placed. 

Next, the wound was irrigated with sterile saline and the subcutaneous layer was reapproximated using buried interrupted 3-0 Vicryl suture, and then the wound was injected with 0.25% Marcaine and Steri-Strips were applied. 

Attention was then directed to the carpal tunnel release

So what I get is 64721 and 64718 due to the fact that he only made the one incision (other than the Carpal tunnel release because that is obvious)
 he wants 64721,64718, and 64719

Any thoughts


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## ASC CODER (Aug 2, 2010)

64721,64718?


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