64721 & 25115

[KatieV7]

My providers are insisting that if they are doing an open carpal tunnel and find flexor tenosynovitis and and then remove it (tenosynovectomy) that we can unbundle the 64721 and 25115 as long as we add a diagnosis of flexor tenosynovitis. This doesn't seem right to me?!?

 

[NRaizman]

Nope.

If you are performing a tenosynovectomy within the carpal tunnel, the carpal tunnel release was incidental to the tenosynovectomy, as it represents the surgical approach.
The GSD note that tenosynovectomy or tenosynovial biopsy is inclusive to carpal tunnel release.

This is a pure money grab, completely inappropriate, and represents willful overcoding, which could easily be considered fraudulent. You should warn your surgeons that persisting in this sets them up for accusations of fraudulent behavior and may lead to potential clawbacks, denials and legal action.

 

[NRaizman]

Nope.

If you are performing a tenosynovectomy within the carpal tunnel, the carpal tunnel release was incidental to the tenosynovectomy, as it represents the surgical approach.
The GSD note that tenosynovectomy or tenosynovial biopsy is inclusive to carpal tunnel release.

This is a pure money grab, completely inappropriate, and represents willful overcoding, which could easily be considered fraudulent. You should warn your surgeons that persisting in this sets them up for accusations of fraudulent behavior and may lead to potential clawbacks, denials and legal action.

Also, feel free to refer them to their professional societies if they don't believe you: ASSH, AAOS and ASPS. They will get the same answer. We see this question over and over and the answer remains the same.