CPT Codes 64721 and 25115

aformato1

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I hope someone can help. I know that CPT code 25115 is considered a component of CPT code 64721. The doctor I work with only wants to bill 25115 instead of 64721 because it has a higher reimbursement. Would that be appropriate?
 

CodingKing

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According to NCCI, 64721 is bundled into 25115 so you can report the 25115

Per the Complete Global Service Data for Orthopedic Surgery, Neuroplasty for surgical exposure is part of the more intensive procedure.
 
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AlanPechacek

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The answer to this depends on the purpose and intent of the procedure. You don't include the description of the procedure, the "Procedure Done," or the Postoperative Diagnosis in you query, but based on what you do present, it appears that your surgeon did an extensive tenosynovectomy of the flexor tendons at the wrist (25115), which usually requires carrying the wound/incision out to the level of the palm of the hand in order to get full exposure and access of the tendons. This requires release of the Transverse Carpal Ligament, which "incidentally" results in a Neurolysis of the Median Nerve (i.e. Carpal Tunnel Release, 64721). The nerve has to be retracted and protected in order to do the tenosynovectomy completely. The Neurolysis of the Median Nerve (64721) would be an incidental procedure and included in the 25115 charge. Even if the patient had both Chronic Tenosynovitis of the flexor tendons and Carpal Tunnel Syndrome, I doubt that you would be able to charge the 64721 separately, even with a Modifier 51 or 22, and get away with it since they are already "Bundled."

Respectfully submitted, Alan Pechacek, M.D.
 

aformato1

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He is performing both procedures. The issue we are having is that when we bill both codes together, they are only paying 64721 which has lower reimbursement and denying 25115 as inclusive. So the doctor just wants to bill 25115 alone. I just wanted to make sure it was ok to bill just 25115. Hand surgery is new to me. After reading your response and the previous one, I believe it shouldnt be a problem.

Thank You.
 
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