Wiki Nerve Wrapping for Ulnar nerve

[kkindle1807]

Hello, can someone please assist

This part of the operative report reads as:
Attention was first turned to the mid aspect of the elbow where a previous surgical incision was identified and utilized. Ulnar nerve was very difficult to find due to extensive scarring. It was identified distally and proximally and traced for the center of the incision. The ulnar nerve fascicles were very prominent with some scarring at this area. All areas of compression were noted by the scar tissue, especially over the medial epicondyle where decompression was first performed. After the ulnar nerve was identified and dissected, Axogen nerve wrap was placed and held in place with Ethibond suture. No compression of the nerve was noted. Attention was then turned to the volar aspect of the hand where a previous Guyon's canal incision was identified. Subcutaneous tissues were carefully divided. The ulnar nerve and the deep motor branch of both identified and noted to be compressing the sign of extension. Proximally, the ulnar nerve was evaluated and antebrachial fascia released.

I was provided with codes 64718, 64719 and 64999. From what I've researched 64718 & 64719 do not include nerve wrapping. What comparison code would you use for the 64999? And would these be the only 3 CPT's you would use?

Any help is appreciated!

 

[NRaizman]

This is a weak op note - if your surgeon wants to be paid more appropriately, he or she should describe the intense work of a revision CuTR and Guyon's release more thoughtfully and fully to justify a -22 modifier.

You can try to use 64999 for the wrap, but good luck getting paid. It is not part of the standard work of 64718, to be sure.

You should be using a -22 modifier for both these codes, but the operative note barely justifies it.

 

[kkindle1807]

This is a weak op note - if your surgeon wants to be paid more appropriately, he or she should describe the intense work of a revision CuTR and Guyon's release more thoughtfully and fully to justify a -22 modifier.

You can try to use 64999 for the wrap, but good luck getting paid. It is not part of the standard work of 64718, to be sure.

You should be using a -22 modifier for both these codes, but the operative note barely justifies it.

And what comparison code would you use for the 64999? I'm not sure of a price to put on it. I do agree with you that a 22 mod is out of the question as the report does not justify it.

 

[NRaizman]

I would compare to 64910.

I think that this case is clearly through an altered surgical field and requires a -22 modifier.

I would recommend a surgical addendum to justify the -22, but any revision case should clearly qualify for it, and it should get paid.