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Wiki Sequencing Modifiers correctly for Carpal tunnel injections.

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carol52

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Hello, I hava Surgery for Carpal Tunnel with injections that I am trying to apply the modifiers correctly and
am asking for some help.
Procedures performed were:
Rt carpal tunnel release.
Left trigger thumb
Left small finger trigger digit injection
Left trigger thumb injection.

I applied:
Carpal tunnel surgery 64721 RT
Aspiration small joint Bursa LFT thumb- 20600 LT
Injection therapeutic carpal tunnel- 20526 XS
 
I think you need to answer some questions first. You have "Left trigger thumb" and "Left trigger thumb injection". Was the A1 pulley released? If it were they would never release the A1 pulley and inject it too. You also have listed a "Right Carpal Tunnel Release" once, but 64721-RT and "Injection carpal tunnel" but you don't say what side it was performed on. Once again you would never perform a CTR 64721 and then inject the same time. It's one or the other and I have had both. The injection only worked for a short time so then they performed the surgery afterwards. Your codes are not matching the procedures listed.
 
Orthocoderpgu said:
I think you need to answer some questions first. You have "Left trigger thumb" and "Left trigger thumb injection". Was the A1 pulley released? If it were they would never release the A1 pulley and inject it too. You also have listed a "Right Carpal Tunnel Release" once, but 64721-RT and "Injection carpal tunnel" but you don't say what side it was performed on. Once again you would never perform a CTR 64721 and then inject the same time. It's one or the other and I have had both. The injection only worked for a short time so then they performed the surgery afterwards. Your codes are not matching the procedures listed.
Click to expand...
Sorry for the disruption of the note... I will give you a clearer view of the op note this time... I did not mean to mention the Trigger thumb twice... and the A1 pulley of the thumb was not released.
Hopefully this is much more of a better picture... sorry for the confusion.
Carol
I will appreciate your expertise....

Injection left Trigger Thumb
Injection, left small finger trigger digit
Rt Carpal tunnel release.

On the Skin I prepped the skin overlying the A1 pulley of the thumb and the A1 pulley of the ring and small fingers. 40 mg Depo-Medrol was injected overlying the A1 pulley of the thumb and between the A1 pulleys of the ring and small fingers, essentially directed the needle toward the small finger for the part of the injection and toward the ring finger for the other..
The right hand and arm were then prepped and a longitudinal incision was made proximal to Kaplans line and distal to the volar wrist crease in line with the radial border of the ring finger. Dissection carried to the subcu.
Dr. spread the palmar fascia and identified the transverse carpal ligament. exposing the median nerve. Identified the motor branch distally and radially and then released the transverse carpal ligament proximally and released the distal 1 cm of the volar forearm fascia. At this point two leaves of the transverse carpal ligament lay open. . the skin was reapproximated and sutured.
 
For future reference make sure you list the diagnosis' as well. That is a huge help especially in orthopedics where a diagnosis can change the cpt that is reported. Your welcome.
 
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