My physician is performing 64721 sometimes when doing 25447 & 25310. The dx code for 64721 is G56.02 and the dx code for 25447 & 25310 is M18.12. The 64721 is done from a separate incision prior to the 25447 & 25310. There are no specific NCCI edits that shows they can't be billed together. But I have read, that since 64721 was a smaller procedure that usually the insurance company will deny 64721. I have had a few denials for this but no other explanation other than it being bundled. Can someone help by explaining??? Below is the op note for reference.
POSTOPERATIVE DIAGNOSES: Left thumb basilar arthritis, left carpal tunnel syndrome.
PROCEDURES PERFORMED:
1. Left thumb CMC arthroplasty with an internal brace.
2. Left wrist FCR weave.
3. Left carpal tunnel release
DESCRIPTION OF PROCEDURE: The patient was seen preoperatively, site was marked and
verified. Preoperative antibiotics were given. She was taken back to the OR. Time-out was taken at the
beginning of the procedure. The arm was exsanguinated. The tourniquet was inflated. An incision was
made at the base of the palm. We carefully dissected down and divided the palmar aponeurosis. The
distal extent of transverse carpal ligament was identified and released with a scalpel. A Freer elevator
was then used to remove any adhesions proximally and then blunt tip scissors were used to complete the
release proximally. Once this was achieved, the wound was closed. A second incision was made along
the mid forearm. The FCR tendon was identified and transected. A third incision was then made at the
radial aspect of the wrist in line with the first dorsal compartment, carefully dissected down protecting the
superficial nerve branches. The first dorsal compartment tendons were then released in longitudinal
fashion. A retractor was placed and the radial artery was then identified and protected to the remainder
of the procedure. Capsulotomy was performed over the trapezium. The trapezium was then removed
with osteotome, rongeur and curette. At this point, the FCR was then withdrawn from the base of the
wound. We then identified the base of the index metacarpal and Arthrex FiberLock anchor was then
passed across the base of the index metacarpal. Once this was secured, the FiberTape was then secured
to the base of the thumb metacarpal using the Arthrex SwiveLock anchor while holding the thumb in slight
traction and radial abduction. This appeared to recreate the trapezial space quite nicely. The FCR tendon
was then sutured to the base of the thumb metacarpal using 2-0 PDS. The remainder of the FCR tendon
was then sutured together with 3-0 Vicryl and placed into the space left by the trapeziectomy. The
capsule was then closed with 3-0 Vicryl as well. The skin was then closed with Monocryl. She was
placed in a thumb spica splint and tolerated the procedure well.
POSTOPERATIVE DIAGNOSES: Left thumb basilar arthritis, left carpal tunnel syndrome.
PROCEDURES PERFORMED:
1. Left thumb CMC arthroplasty with an internal brace.
2. Left wrist FCR weave.
3. Left carpal tunnel release
DESCRIPTION OF PROCEDURE: The patient was seen preoperatively, site was marked and
verified. Preoperative antibiotics were given. She was taken back to the OR. Time-out was taken at the
beginning of the procedure. The arm was exsanguinated. The tourniquet was inflated. An incision was
made at the base of the palm. We carefully dissected down and divided the palmar aponeurosis. The
distal extent of transverse carpal ligament was identified and released with a scalpel. A Freer elevator
was then used to remove any adhesions proximally and then blunt tip scissors were used to complete the
release proximally. Once this was achieved, the wound was closed. A second incision was made along
the mid forearm. The FCR tendon was identified and transected. A third incision was then made at the
radial aspect of the wrist in line with the first dorsal compartment, carefully dissected down protecting the
superficial nerve branches. The first dorsal compartment tendons were then released in longitudinal
fashion. A retractor was placed and the radial artery was then identified and protected to the remainder
of the procedure. Capsulotomy was performed over the trapezium. The trapezium was then removed
with osteotome, rongeur and curette. At this point, the FCR was then withdrawn from the base of the
wound. We then identified the base of the index metacarpal and Arthrex FiberLock anchor was then
passed across the base of the index metacarpal. Once this was secured, the FiberTape was then secured
to the base of the thumb metacarpal using the Arthrex SwiveLock anchor while holding the thumb in slight
traction and radial abduction. This appeared to recreate the trapezial space quite nicely. The FCR tendon
was then sutured to the base of the thumb metacarpal using 2-0 PDS. The remainder of the FCR tendon
was then sutured together with 3-0 Vicryl and placed into the space left by the trapeziectomy. The
capsule was then closed with 3-0 Vicryl as well. The skin was then closed with Monocryl. She was
placed in a thumb spica splint and tolerated the procedure well.