Wiki Brown Endoscopic Carpal Tunnel Release

[bertrandr]

I need help coding this procedure. My physician states that there is not a code and I should use a generic surgery code to bill the surgery. His argument is that he is not doing an open CTR. He is making a tiny incision which doesn't require sutures. I'm not comfortable doing this if there is actually an appropriate code or combination of codes. If there is no appropriate code, how do you go about recommending to the AMA to develop one? It appears that more and more physicians are using this type of procedure.

Operative Report:
The proximal portal was marked out in the distal wrist crease proximal to the glabrous skin. An incision was made with a 15-blade just through the skin. A hemostat was utilized to expose the antebrachial fascia. The antebrachial fascia was released and opened to allow instrumentation into the anterior compartment of the forearm.

The elevator was placed at this level and advanced sitally under the retinaculum, and the soft tissue was elevated off of the retinaculum. The cannula and trocar was then placed deep to the retinaculum. The hand was held in extension over a rolled towel by the assistant.

The cannula was advanced to the side of the distal protal and held by the surgeon while the assistant pushed the excess tissue out of harm's way with a hemostat. A small incision was made in the skin, allowing the cannula to be brought through.

The obturator was then removed from teh cannula, and the assistant inserted the endoscope into the distal aspect of the cannula. The undersurface of the retinaculum was cleared adn confirmed visually via the endoscope. The hook knife was then utilized to divide the retinaculum while the physician assistant, who was assisting, assisted surgeon allowing for consistent visualization throughout the length of the release. There ws good spreading of the retinaculum.

The instrumentation was removed, and the portals were closed with Steri-Strips. A compressive ACE was applied, and pressure was held while the trouniquet was dropped.

Thanks!

 

[PLAIDMAN]

how about 29848 ?

 

[bertrandr]

Assist at Surgery-29848

This is the code that I suggested using to the physician but he states that this code does not allow an assistant surgeon. He wants the assistant surgeon paid. The only documentation that I can find for this code states that "Assist at Surgery or Co-Surgeons" or not paid.

How do I justify to the auditor that this surgery requires an assistant surgeon when other endoscopic wrist surgeries do not.

Thanks!

 

[nrichard]

I have a surgeon like that, he wants me to bill an assistant surgeon for his PA on ev

I just have to put my foot down (in a nice way), and tell him, that I have to code what you did, and I can't create a claim for the PA when the CMS fee schedule says a surgical assist isn't necessary. What our surgeons want to get paid, and what insurance companies are willing to pay are two different things!
You have to code what was done, not what he wants. 29848 is what was done.
If you have the coding companion, I'd print out the description of this code and show the surgeon, you may have to get your Manager involved to go with you to speak with the physician.