Orthopedic Coding Alert

Question: Is there anything that might trip us up when coding for endoscopic carpal tunnel release? The ICD and CPT codes seem clear-cut.

Anonymous Maryland Subscriber

Answer: The codes are clear-cut, according to coders with whom we spoke. Use 354.0 (carpal tunnel syndrome, pain and tingling, numbness or burning in the hand[s] caused by compression of the median nerve[s] by tendons) and 29848 (endoscopy, wrist, surgical, with release of transverse carpal ligament).

Margarita Cordova, CPC, billing manager for the Miami Hand Clinic and a coding consultant for the Phy-Med Group, says, The only problem we have is when we use endoscopic carpal tunnel release with another procedure. For example, if there is a carpal fracture, we use a -59 modifier and code the fracture first. You should get paid for both.

The presence of a modifier -59 (distinct procedural service) might cause a few payers to try to combine (reduce) payment because they see two procedures done during the same session or on the same day, and begin to ask how they are linked, even if they are not. (In that case) what a practice needs to do is negotiate with their payer, says Cordova.

Note: Broken bones in the wrist, as well as other conditions can aggravate carpal tunnel syndromepressure on the median nerve (media neuropathy). The correspondence between conditions causes some insurers to want to combine payment for their treatment.

Cordova also notes many practices have a complaint that has nothing to do with coding difficulties. She says, Some practices dont like the reimbursement rate for the arthroscopic procedure. If its an HMO, we try to carve out a rate were comfortable with.

William A. Heller, MD, and orthopedic surgeon at Midland Orthopedic Associates in Chicago, agrees with Cordova. Heller explains that in the past 29848 was valued at half as much as the code used for an open procedure, 64721 (neuroplasty and/or transposition, median nerve at carpal tunnel). And the value is not what you are reimbursed, he emphasizes.

That has been resolved, says Heller, with the 2000 Physician Fee Schedule. The 2000 National Physician Fee Schedule, published by the Health Care Financing Administration (HCFA), puts the work RVU (relative value unit) for 64721 (open procedure) at 4.29 and the work RVU for 29848 (endoscopic procedure) at 5.44.