Wiki Nerve wrapping - once again my hand surgeon is asking about billing

[jstephen]

once again my hand surgeon is asking about billing for nerve wrapping when he uses a vein graft to wrap the nerve after doing a carpal or cubital tunnel release for a recurrent problem - he wants to use 64910 which is for nerve repair - Margie's article from the Orthopedic Pink Sheet October 2010 states that "using the graft as a barrier against adhesions, but there's no tear, so it's not a nerve repair" - this is what my doc is doing - the article also says that preventative wrapping is not separately billable from the release - doc says that he is doing a repair because he is decompressing the nerve - does anyone have any recent info from a "reliable source" on billing 64910 with 64721 and/or 64718? - doc also wants to be able at least bill 20926 for harvesting the vein to do the graft - is any of this allowed?

 

[OCD_coder]

I believe your CPT guidelines state "includes nerve wrapping" inclusive of the decompression and not billable separately. You can however, bill for the harvesting of the graft as it is not inclusive.

Many CPT codes includes the graft as part of the primary procedure.

 

[MI_CODER]

I just wanted to give some updated information regarding neuroplasty with nerve wrapping.

Per CPT Assistant, December 2013 Page: 14 Category: Frequently Asked Questions:

Surgery: Nervous System

Question: Does code 64721, Neuroplasty and/or transposition; median nerve at carpal tunnel, include the work of wrapping the median nerve with a nerve conduit?

Answer: No. Code 64721 does not include nerve wrapping. If nerve wrapping is performed, it would be separately reported with code 64999, Unlisted procedure, nervous system.

I'd also like to point out that the guidelines under Neuroplasty in the 2018 CPT book (page 418) state, "For neuroplasty with nerve wrapping, see 64702-64727, 64999)."

 

[kalimadak]

What would be the appropriate comparable code for the unlisted 64999 for nerve wrapping?

 

[KimberlySherman]

Note that CPT now includes nerve wrapping in the neuroplasty & decompression codes.

 

[RaquelBorja]

KimberlySherman, where does CPT include nerve wrapping?

 

[KimberlySherman]

It is in the CPT surgery guidelines:

 

[lfollebout]

It is in the CPT surgery guidelines:

View attachment 5364

This is interesting, it does show like this in Encoderpro, but when you look in the CPT book it says "for neuroplasty with nerve wrapping see 64702-64727, 64999" which goes along with Set_Apart's response.

 

[RaquelBorja]

Thank you, I found it, what code do we compare it to? 649XX codes?

 

[apoland]

This is interesting, it does show like this in Encoderpro, but when you look in the CPT book it says "for neuroplasty with nerve wrapping see 64702-64727, 64999" which goes along with Set_Apart's response.

I interpret this as if you are doing a nerve wrap at the same time as any of the work described by codes 64702-64727 the wrap is included. If you are preforming a nerve wrap alone or with another procedure outside of the work in that code range, you would select 64999.