Wiki Carpal Tunnel Release w/Partial Flexor Synovectomy

[Jazmina10]

Hi all,

I have been struggling with this procedure since I started ortho last year. My issue is that this particular provider wants me to bill 64721 and 25118. Although they have no CCI edits I received a couple back being denied from the previous coder. Can someone possibly read this report (it's always the same verbiage) and tell me if these codes are appropriate and/or if anyone bills them together has it paid...

"a curvilinear incision was then made without difficulty through the skin and subcutaneous tissues identifying the palmar fascia. Dissection was then carried down to identify the transverse carpal ligament. Then from a proximal to distal fashion, the transverse carpal ligament had been released without difficulty. The median nerve was identified and decompressed from a proximal to distal fashion and the median nerve was protected at all times. The thickened flexor synovium was had removed with careful dissection, completing the partial flexor synovectomy."

Thank you so much in advance

 

[NRaizman]

Flexor tenosynovectomy and/or tenosynovial biopsy are included in carpal tunnel release. Not separately reimbursable. Bad actors have used this as a means to increase reimbursement but it is routinely denied, as it should be.

In the -exceedingly rare- case in which there is massive tenosynovitis and the radical tenosynovectomy code is used, the carpal tunnel release is incidental as it is part of the exposure.

This has been consistently affirmed by AAOS and ASSH, btw.

 

[Jazmina10]

I can't thank you enough for your response. I have fought with this for over a year now and I can't seem to build a good enough case. I have gone back to the provider many times and since it doesn't have CCI edits he pushes for it harder. I very much needed this. Thank you again

 

[amyjph]

I can't thank you enough for your response. I have fought with this for over a year now and I can't seem to build a good enough case. I have gone back to the provider many times and since it doesn't have CCI edits he pushes for it harder. I very much needed this. Thank you again

You should have denials and/or takebacks if these are making it through and/or even being paid. If you have a data analyst or can pull it yourself, pull a timeframe (6 mos. - one year) of these CPT billed together and see what the financials look like. 64721 is a common case so you should probably have a lot to look at if the provider is busy. Maybe it doesn't have an edit but if the provider is routinely doing this it should have been or will be flagged by the carriers. What diagnosis could be attached to the 25118? Carpal tunnel syndrome is not going to support this.
Do you have a current copy of the AAOS Global Service Data? It shows right there it is included.
Are there hand surgery peers to compare to in the group? You can run a CPT utilization/frequency report.

If you have exhausted all avenues and the provider still wants to consistently do this, why have a coder at all? Have you talked with your manager or compliance team for help in figuring it out? Either way, I would be looking at my denials, rejections, and take backs first.