# 64718 with 24305



## ASC CODER (Jan 11, 2010)

I know that 64718 is bundled with 24305 so this is what i have

24305  rt 354.2

WHAT ABOUT 64719 FOR THE NEUROLYSIS WHICH WAS DISTAL. AND NOT BUNLDLED. 

PLEASE ANY FEEDBACK!

Just wanted another pair of eyes on this to make sure I was not missing something. 
Diagnosis is right cubital tunnel syndrome



DESCRIPTION OF PROCEDURE:
After informed consent was obtained, the patient was brought to the operating room suite and placed on the operating table in supine position. A pause was undertaken to confirm the patient, as well as the location of surgery. Once this was confirmed, general anesthesia was induced without difficulty and the patient’s hand and forearm were prepped with a Betadine scrub and paint and draped in a normal sterile fashion. An Esmarch bandage was used to exsanguinate the extremity and an upper arm tourniquet was inflated to 250 mmHg. A curvilinear incision was made over the expected course of the ulnar nerve and tenotomy scissors were used to dissect down through the soft tissues to the level of the muscle fascia. A single medial endobronchial cutaneous nerve branch was identified and protected throughout the procedure. An incision was made overlying the fascia directly over the ulnar nerve and the ulnar nerve was identified proximally just adjacent to the medial intermuscular septum and traced distally through the cubital tunnel. At the level of the medial epicondyle there was a significant amount of scar tissue, as well as the anconeus epitrochlearis muscle, which was divided under direct visualization. The nerve was run completely through the cubital tunnel distally into the flexor carpi ulnaris fascia. Circumferential dissection was then undertaken from a proximal to distal fashion as well. Distally there was a small flexor carpi ulnaris nerve branch, which required proximal neurolysis to allow for a tension-free anterior transposition. Once this had been achieved Z-lengthening and the flexor pronator mass was undertaken. An incision was made in the flexor pronator fascia and fascial flaps were raised. The flexor pronator mass septa were identified and divided down as deep as possible to prevent these from being additional points of compression. The muscle was taken down to the brachialis muscle proximally and distally to this same depth. Once this was confirmed, the nerve was transposed into the muscular bed and the Z-lengthened fascial flaps were reapproximated using a series of interrupted 3-0 Vicryl sutures. Adequacy of space for the nerve was confirmed by the ability to pass two fingers along with the nerve underneath the fascial flaps. A final check was made proximally and distally for any additional points of compression and none were identified. The tourniquet was then released with a total tourniquet time of approximately 29 minutes. Hemostasis was obtained using bipolar electrocautery. The wound was irrigated with normal saline and the incision was then closed using 3-0 Vicryl in the deep dermal plane and a running 4-0 nylon horizontal mattress suture. A dressing was applied consisting of Xeroform, dry gauze, and a long-arm splint placing the elbow in 90 degrees of flexion, the forearm in neutral rotation, the wrist in neutral position, and the fingers and thumb were left free. This was secured with ACE wrap. The patient was then awakened from anesthesia, transferred to the hospital bed, and taken to the postanesthesia care unit in stable condition.


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