Coding for a Balloon Carpal Tunneloplasty

MyIvana815

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I have a surgeon that is now doing balloon access Carpal Tunnel Surgery. I am not sure where to go on this. Of course the surgeon has the Vendor saying we can code it one way and as most of us know they aren't always correct and just want to entice the "money" that the surgeon can be reimbursed. They are suggesting to use 11960 which I am interpreting that CPT code as being placed till final reconstruction is done and this would not be the case. I am just looking at 29848 thinking that your not able to code for the balloon portion of the procedure. Any suggestions?



POSTOPERATIVE DIAGNOSIS: Significant right carpal tunnel syndrome, which failed conservative treatment.

OPERATION PERFORMED: Right carpal tunnel release endoscopically with balloon access.

DESCRIPTION OF PROCEDURE: the patient was seen in the preoperative area. The correct site surgery was marked. Prophylactic antibiotics were given to the patient prior to surgery. The patient was brought to the operating suite. Sedation was provided by the Department of Anesthesia and the right upper extremity was sterilely prepped. Sterile drapes were applied. The arm was elevated, exsanguinated with an Esmarch bandage, and tourniquet was inflated. Utilizing the specialized handset, we placed the patient's hand in a dorsiflexed position. Utilizing a sterile marking pen, an incision was mapped out over the volar ulnar aspect of the wrist in line with the ring finger. Skin flaps were developed. The fascia was incised. My assistant lifted the fascia up with a Ragnell retractor. The Freer was placed underneath the transverse carpal ligament and found to be very tight. Utilizing the balloon access, this was placed underneath the transverse carpal ligament and the balloon was locked in place and elevated to 12 atmospheres. This was performed on three separate occasions at 30 seconds.



The balloon was removed from underneath the transverse carpal ligament and inspection with the Freer demonstrated expansion of the transverse carpal ligament. The endoscope was placed in the carpal tunnel and with correct visualization utilizing a sickle blade, the transverse carpal ligament was released and intraoperative photograph was obtained with the endoscope. We placed the balloon back into the transverse carpal ligament and found it was completely free after expanding it to 12 atmospheres. The wound was sterilely irrigated. Tourniquet was deflated. Excellent hemostasis. The incision was closed with 5-0 Prolene. A sterile compressive dressing was applied. She tolerated the procedure well. No complications.
 
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