Wiki CPT code 25020 & 29848

[medcode]

I need help with this coding combination:

Procedure: endoscopic carpal tunnel release & distal forearm fasciotomy

This is the extact wording of the operative report:

First, attention was turned to the carpal tunnel where a 1 cm transverse incision over the proximal wrist flexion crease, starting at palmaris longus, extending ulnar-ward. Sharp dissection through skin. Hemostasis with bipolar electrocautery. Blunt dissection used to identify the distal forearm fascia which was split transversely. Next, the blunt dissection was carried out subcutaneously over the forearm fascia for 4cm proximal to the skin wound, and the undersurface of the fascia was also dissected free from the median nerve. Next, the fascia was divided with the scissors for 4cm proximal to the skin wound, creating a fasciotomy. This fasciotomy was continued distally for 1cm, exposing the proximal edge of the transverse carpal ligament. Transverse carpal ligament was divided for 5mm on its proximal edge to open the canal. The Segway endoscopic carpal tunnel system was used to assist in the carpal tunnel release. The soft tissue elevator was used to elevate the soft tissue from the undersurface of the ligament. Several blunt dilators were used to dilate the canal. The endoscopic guide was placed in the carpal canal to a depth of 4cm. Next, the arthroscope was introduced into the radial portion of the guide. The undersurface of the transverse carpal tunnel ligament was well visualized with its transvers carpal ligament from distal to proximal under direct vision with the arthroscope, with several passes of the knife. There was found to be good parallel division of the edges of the ligament with the interceding fat and loss of tension. The guide was removed.

My question: I do not get edits when these two codes are used in combination. However, it appears that the fasciotomy is a component of the carpal tunnel release. ANy help would be appreciated.

 

[debb]

29848 and 25020

I have the very same question. ANYBODY OUT THERE KNOW THE ANSWER? I don't have AAOS re: 29848. Most recently it was just pointed out to me that per AAOS code 25020 includes --extension of incision to include transverse carpal ligament. Additionally please know the only incision made was as follow--

Transverse skin incision was marked out approximately 1 cm proximal to the distal wrist crease beginning from the midline and marking ulnarward. Skin makes were marked 3 and 4 cm distal to the distal wrist crease in line with the ring finger. Extremity was exsanguinated and tourniquet inflated.

Transverse skin incision was made proximally and subcutaneous tissue was divided taking care to protect and preserve sensory nerve branches and control bleeders with bipolar cautery.” The procedure concludes, "The ligament was divided in its entirity. The endoscope and cannula were removed and volar forearm fasciotomy was performed dividing the distal 4 cm of volar forearm fascia under direct vision with the scissors. The wound was inrrigated and closed with interrupted sutures."

I have also seen same provider report same procedure on other patient but closed with steri strips.

 

[MPopkin]

I am sure we must have an answer to this by now but I do not see this thread answered. Can I be directed to authoratative guidance or does anyone have access to 2023 AAOS GSD book?

 

[Orthocoderpgu]

I am sure we must have an answer to this by now but I do not see this thread answered. Can I be directed to authoratative guidance or does anyone have access to 2023 AAOS GSD book?

Code 25020 is performed to treat compartment syndrome. The incisions can be very long. I have seen them go pretty much from wrist to elbow almost. This is because a "compartment" is filling with fluid such as blood. Think of blowing up a balloon. If this happens inside the body, it becomes a medical emergency. If the compartment continues to fill it's going to cause damage to the surrounding area. In this case the provider is just making a small opening (surgical approach) to release the transverse ligament. He's not treating compartment syndrome.