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Wiki Anyone code carpal tunnel releases?

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Melanie Daugherty

Melanie Daugherty

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My question is regarding the CPT code for internal neurolysis requiring operating microscope. Just curious as to when any of you would add 64727 in addition to the CTR, 64721. The description for 64727 reads:

The physician makes an incision over the affected nerve and locates the nerve. The physician resects the nerve sheath parallel to the fibers and releases scar tissue within the nerve.

Thanks!
 
Hopefully this will help-its from the CPT assistant

Nervous System, Surgery, 64702-64727 (Q&A)

Body: Coding Consultation

Question

Code 64727 describes internal neurolysis. The parenthetical note following this code states that neuroplasty includes external neurolysis. What is the difference between internal and external neurolysis?

AMA Comment

As stated in the usage guidelines for codes 64702-64726, neuroplasty is the decompression or freeing of intact nerve from scar tissue, including external neurolysis and/or transposition. External neurolysis is used to evaluate the nerve to determine if segmental nerve resection and suture are indicated and to enhance regeneration when resection and/or suture are not performed. External neurolysis includes division of perineural adhesions and/or excision of perineural scar tissue.

Some procedures may require internal neurolysis, which involves the microscopic excision of scar tissue from between nerve fascicles to enhance nerve regeneration after nerve injury or suture/repair. Code 64727, Internal neurolysis, requiring use of operating microscope (List separately in addition to code for neuroplasty), should be reported in addition to external neuroplasty when scar tissue is microscopically excised from between the nerve fasicles.
 
Dont be ever driven by mere use of microscope. Docs do this a lot of times. they would just document the use of microscope and would not document the essential elements for internal neurolysis, and of course, you cannot code it on those grounds.
Good Luck!
 
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