Wiki Coding 64718 and 24359

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Rochester, NY
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Hi,

Does anyone know if there is a way to get 24359 paid when billed with 64718? My surgeon made two separate incisions and used two different diagnosis codes for the procedures. We tried to bill the 24359 with the 59 modifier and it has come back denied (no surprise). I've tried to explain the NCCI edit to him, but he is frustrated that he cannot be reimbursed for the additional work.
 
Page 443 CPT AMA 2020 edition - definition of neuroplasty is spelled out so it's no wonder they won't pay the 24359 no matter what modifier you slap on it. The 24359 has to do with the tendon and the 64718 is focused on the nerve - 2 different animals.
 
What exactly was the procedure your provider was performing. I cannot suggest codes or modifiers without seeing the op note.
Hi Debra,

He did a 1) Left cubital tunnel release and 2) Left lateral epicondylar debridement and repair.

OP Report States:
"A curvilinear incision was carried out between the epicondyle and the olecranon. Sharp dissection through the skin. Gentle dissection through the subcutaneous tissue. Care was taken not to injure the crossing branches. Dissection started out proximally. The ulnar nerve was identified with careful dissection. It was released proximally. The sheath was opened overlying the ulnar nerve, and this was followed carefully up to and around the epicondyle. The sheath was then completely opened until the FCU was identified. The FCU was split. The nerve was followed into the FCU until there was no evidence of compression. The elbow was brought into full range of motion, and the nerve did not ride over the epicondyle.

Longitudinal incision was carried out over the lateral epicondyle with about a 2" incision. Sharp dissection through the skin and cautery through the fat. The fascia was identified. The ECRL and extensor common origin were identified and split longitudinally. The ECRL was elevated. The undersurface was identified along with degeneration of the ECRB. Debridement was carried out elliptically. Adequate debridement was carried out with a #15 blade and rongeur. Partial ostectomy was carried out over the epicondyle where necessary. Multiple perforations of the epicondyle insertion site were created with a 0.045" k wire. The wound was copiously irrigated."
 
I am not able to get a good picture in my head for this patient, is this due to an injury? What is the diagnosis the patient has that led to the surgery. Is this a tennis elbow, what is the exact nature of the problem. Because what is happening is you cannot code these procedures together. Now if you have a really good rational for why you want to code them separately it can be done but so far I am not seeing anything. You are going to need to provide me with the whole back story on this.
 
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