jdibble
True Blue
Hello Coders!
I am hoping someone can help me with this surgery! We have a doctor who did a revision carpal tunnel surgery and one of our coders coded it with 64721. The doctor also did a nerve wrap to avoid swelling post-op and wanted to bill for that. The vendor told her she could bill with 64910 which of course bundles with 64721. She requested a review of the surgery and a supervisor advised to code the surgery as 25115 and 64910. I am not sure that is the correct way to code this surgery either. I am looking for some opinions on how others code this as I have really never coded a revision carpal surgery.
Indications: Patient is having a procedure for RECURRENT RIGHT CARPAL TUNNEL SYNDROME. Initial surgery was in 2014 done endoscopically on this side and more recently recurrence of symptoms. Operative and non-operative treatment options were discussed with the patient. Risks and benefits were explained to the patient. Informed consent was obtained. Patient has elected to proceed with surgical intervention today.
Procedure Details: Patient was identified in the pre-op holding area. Operative extremity was marked. Patient was brought to the operating room by the nursing team. The patient was positioned on a well-padded OR table and operative extremity placed on a hand table. Patient verification was done upon entering the room.
General anesthesia was administered & LMA was placed. Non-sterile tourniquet was applied to the upper arm. Operative extremity was prepped and draped in usual sterile fashion.
Pre-operative timeout was done to confirm operative, site, operative plan, that instruments/equipment were ready & available, that antibiotics were being delivered, and we were in agreement.
An Esmarch bandage was applied and tourniquet inflated to 250 mmHg.
Patient's right upper extremity was positioned on a Tupper hand retractor. A standard carpal tunnel incision was drawn out along with extension across the wrist avoiding the palmar cutaneous branch of the median nerve. I incised through skin subcutaneous tissue. I elevated full-thickness skin flaps proximally being careful to identify the median nerve which was radial in the incision and not tethered by any scar proximal to the wrist crease. There was compression of the nerve with transverse crossing tight tissue at the wrist crease. There was visible compression on the nerve. This was carefully released. The remainder of the carpal tunnel release was then proceeded from proximal to distal direction. There was thickened fascia from the palmaris brevis muscle in the most distal aspect of the wound and very tight & thick tissue distally. The release was completed and the flexor tendons were noted to have some thickened tenosynovium especially along the FPL in the radial aspect of the wound. Flexor tenosynovectomy was performed. The median nerve itself was inspected and was noted to be tethered in scar tissue on the radial aspect just distal to the wrist crease. This tethered tissue was excised. This area was marked out and then wrapped with a collagen Axogen nerve wrap which was HA+ nerve guard measuring 2x4cm. The wrap was performed around the previously tethered area of scar tissue and space was left for swelling of the nerve postoperatively. The wrap was secured with 8-0 nylon in interrupted fashion. The surgical dissection and work required for revision carpal tunnel release was substantially greater than typical for a standard carpal tunnel release.
The tourniquet was released. Hemostasis was obtained. Wound was thoroughly irrigated copiously with normal saline. The incision was closed with a combination of 3-0 and 4-0 nylon suture in interrupted fashion using the larger suture at the wrist crease. Local anesthesia of 1% lidocaine with epinephrine was instilled along the incision. Xeroform followed by 4x4s were applied. Patient was placed into a plaster short-arm resting splint for the wrist.
All fingers are warm and well perfused at the end of the case. Patient was awakened from anesthesia without difficulty and transferred to the stretcher and taken to the PACU in stable condition.
Findings: Compression of the median nerve at the wrist crease. Flexor tenosynovitis of the FPL tendon.
Complications: None; patient tolerated the procedure well.
Disposition: PACU - hemodynamically stable.
Condition: stable
Attestation: I was present and scrubbed for the entire procedure.
Thank you for all of your excellent help with this!
Jodi
I am hoping someone can help me with this surgery! We have a doctor who did a revision carpal tunnel surgery and one of our coders coded it with 64721. The doctor also did a nerve wrap to avoid swelling post-op and wanted to bill for that. The vendor told her she could bill with 64910 which of course bundles with 64721. She requested a review of the surgery and a supervisor advised to code the surgery as 25115 and 64910. I am not sure that is the correct way to code this surgery either. I am looking for some opinions on how others code this as I have really never coded a revision carpal surgery.
Indications: Patient is having a procedure for RECURRENT RIGHT CARPAL TUNNEL SYNDROME. Initial surgery was in 2014 done endoscopically on this side and more recently recurrence of symptoms. Operative and non-operative treatment options were discussed with the patient. Risks and benefits were explained to the patient. Informed consent was obtained. Patient has elected to proceed with surgical intervention today.
Procedure Details: Patient was identified in the pre-op holding area. Operative extremity was marked. Patient was brought to the operating room by the nursing team. The patient was positioned on a well-padded OR table and operative extremity placed on a hand table. Patient verification was done upon entering the room.
General anesthesia was administered & LMA was placed. Non-sterile tourniquet was applied to the upper arm. Operative extremity was prepped and draped in usual sterile fashion.
Pre-operative timeout was done to confirm operative, site, operative plan, that instruments/equipment were ready & available, that antibiotics were being delivered, and we were in agreement.
An Esmarch bandage was applied and tourniquet inflated to 250 mmHg.
Patient's right upper extremity was positioned on a Tupper hand retractor. A standard carpal tunnel incision was drawn out along with extension across the wrist avoiding the palmar cutaneous branch of the median nerve. I incised through skin subcutaneous tissue. I elevated full-thickness skin flaps proximally being careful to identify the median nerve which was radial in the incision and not tethered by any scar proximal to the wrist crease. There was compression of the nerve with transverse crossing tight tissue at the wrist crease. There was visible compression on the nerve. This was carefully released. The remainder of the carpal tunnel release was then proceeded from proximal to distal direction. There was thickened fascia from the palmaris brevis muscle in the most distal aspect of the wound and very tight & thick tissue distally. The release was completed and the flexor tendons were noted to have some thickened tenosynovium especially along the FPL in the radial aspect of the wound. Flexor tenosynovectomy was performed. The median nerve itself was inspected and was noted to be tethered in scar tissue on the radial aspect just distal to the wrist crease. This tethered tissue was excised. This area was marked out and then wrapped with a collagen Axogen nerve wrap which was HA+ nerve guard measuring 2x4cm. The wrap was performed around the previously tethered area of scar tissue and space was left for swelling of the nerve postoperatively. The wrap was secured with 8-0 nylon in interrupted fashion. The surgical dissection and work required for revision carpal tunnel release was substantially greater than typical for a standard carpal tunnel release.
The tourniquet was released. Hemostasis was obtained. Wound was thoroughly irrigated copiously with normal saline. The incision was closed with a combination of 3-0 and 4-0 nylon suture in interrupted fashion using the larger suture at the wrist crease. Local anesthesia of 1% lidocaine with epinephrine was instilled along the incision. Xeroform followed by 4x4s were applied. Patient was placed into a plaster short-arm resting splint for the wrist.
All fingers are warm and well perfused at the end of the case. Patient was awakened from anesthesia without difficulty and transferred to the stretcher and taken to the PACU in stable condition.
Findings: Compression of the median nerve at the wrist crease. Flexor tenosynovitis of the FPL tendon.
Complications: None; patient tolerated the procedure well.
Disposition: PACU - hemodynamically stable.
Condition: stable
Attestation: I was present and scrubbed for the entire procedure.
Thank you for all of your excellent help with this!
Jodi