# Ulnar Nerve Release Revision



## Kae Hunter CPC (Jul 7, 2010)

Does anyone know an appropriate CPT code for revision of an ulnar nerve release?


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## KellyLR (Jul 7, 2010)

*Ulnar release*

I'd like to understand a bit more here. I would want to know of the location of where that ulnar release was done, wrist, elbow, or arthroscopic, etc. And also it would probably take a modifier such as -78 if applicable to postoperative period.
best regards


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## Robin M. (Jul 7, 2010)

*Response:Ulnar Nerve Release Revision*

Kae, 

I am not certified yet, but your question gives me a chance to have some practice while I am studying to take my exam. At any rate here is what I believe the CPT code is for your question if at the elbow it is...64718 and if it's at the wrist then it is..64719. 

Regards,

Robin M


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## KellyLR (Jul 7, 2010)

*revision Ulnar release*

Robin,

Good answer, but I think she already knows that from just looking in the CPT index.  FYI, the ulnar nerve weaves in/out of several areas up/down the arm affecting several assumptions.  Most generally, when the ulnar is involved, it is usually entrapment of some type and usually at the elbow. That is why I wanted more info.  I can't wait until ICD-10.


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## Kae Hunter CPC (Jul 8, 2010)

Ulnar nerve release was open at the elbow.  I really do not know what the doctor is planning.  He just asked if there was a code for revision of an ulnar nerve release.  Originally, I thought it would probably just be a repeat of the original procedure.

Thanks so much for your reply.

Kae Hunter, CPC


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## KellyLR (Jul 8, 2010)

*Kae, I found this on AAOS*

I found this that might shed some light from the AAOS website:

Revision CTR
At times, a redo or revision carpal tunnel release (CTR) can require more work than the initial surgery. In some cases, fascial grafting or hypothenar fat grafts must be fashioned to help prevent further recurrence. The AAOS Global Service Data Book (GSD) includes the following procedures in a CTR: division of transverse carpal ligament with or without Z-plasty or other local tissue rearrangement; tenosynovectomy/tenolysis of flexor tendon(s); excision of lipoma of carpal canal; exploration/incidental release of ulnar nerve; release of distal forearm fascia; and use of scope equipment.
Excluded from a CTR are: internal neurolysis of the median nerve with decompression of pathology requiring internal neurolysis with use of an operating scope; neuroplasty of ulnar nerve for documented ulnar neuropathy; and wrist arthrotomy/synovectomy.
The current coding options for a repair/revision CTR are 64721-22 (if there is supporting documentation of more extensive work) or unlisted 64999. The AAOS Coding, Coverage and Reimbursement Committee is evaluating the possibilities for CTR revisions to determine whether additional reporting for the grafting (20926) can be allowed rather than developing a new revision code. The goal is to expand the use of existing resource value unit (RVU)-rated codes instead of adding new codes that could reduce the RVU for existing codes.
Another concern when doing CTR is the ability to report release of the ulnar nerve. To report both median and ulnar nerve release, the supporting documentation must indicate that the patient has ulnar neuropathy. This requires both a separate preoperative diagnosis (establishing medical necessity) and operative notes. Otherwise, the ulnar exploration/release could be considered inherent and thus not separately reportable.
Kevin J. Bozic, MD, MBA, is assistant professor in residence, University of California – San Francisco Department of Orthopaedic Surgery, and a member of the AAOS Coding, Coverage and Reimbursement Committee. He can be reached at bozick@orthosurg.ucsf.edu

http://www2.aaos.org/aaos/archives/bulletin/aug05/coding.asp

That is where i found this info, it appears that there is a Diag code needed prior to even doing this type of surgery, but check out the whole article. It says very little about revision.
Best Regards,


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