hypothenar fat pad flap

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terese74

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Does any one know how to code a hypothenar fat pad flap when doing a revision carpal tunnel release? we have been using 17999 but I have come across some stuff saying to use 14040. we have been told we cannot bill it separately but i dont agree. does anyone have any documentation on wether or not it can be billed separately?
Thanks so much for any help.:D
 
My doctors use 14040.
My online software shows no bundling issues.
I have attached a copy of the info.

Validation Results Office - CCI Version 14.0CodeDescription

14040

Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less

There are no bundling issues for this code


64721

Neuroplasty and/or transposition; median nerve at carpal tunnel

There are no bundling issues for this code
 
CPT Assistant Information RE: Fat Pad

CPT ?Assistant, August 2009, Volume 19, Issue 8, page 11



Surgery/Nervous SystemQuestion:

A patient is seen for recurrent carpal tunnel -syndrome. The physician performs a revision right carpal tunnel release with a local ulnar fat pad rotation flap and reports code 64721, Neuroplasty and/or transposition; median nerve at carpal tunnel. The procedure report states that the ulnar fat pad was rotated on the distally based flap and used to cover the median nerve. Would this procedure be reported separately and, if so, which code should be reported?



Answer:

Code 64721 is the appropriate code to report the carpel tunnel release; however, there is no specific code for fat pad coverage of the median nerve. If the size of the fat pad and the amount of work involved are significant, then modifier 22, Increased Procedural Services, may be appended to code 64721. Records should reflect the size of the flap and the amount of work that is over and above the usual procedure. It is not appropriate to report a flap/graft service from the Integumentary System for this technique.
 
Hand Surgery Quarterly - Spring 2010 - American Association of Hand Surgery

Use of a hypothenar fat pad flap to cover the nerve after exploration would correspond to a code for adjacent tissue transfer; an appropriate code would be 14040, which describes adjacent tissue transfer or rearrangement for the hands for a defect of 10 square centimeters or less.
 
CPT ASSISTANT August 2009 Page 11 Coding Consultation
Question: A patient is seen for recurrent carpal tunnel syndrome. The physician performs a revision right carpal tunnel release with a local ulnar fat pad rotation flap and reports 67421, Neuroplasty and/or transposition; median nerve at carpal tunnel. The procedure report states that the ulnar fat pad was rotated on the dismally based flap and used to cover the median nerve. Would this procedure be reported separately and, if so, which code would be reported?
Answer: Code 64721 is the appropriate code to report the carpal tunnel release; however, there is no specific code for fat pad coverage of the median nerve. If the size of the fat pad and the amount of work involved are significant, then modifier 22, Increased Procedural Services, may be appended to code 64721. Records shou reflect the size of the flap and the amount of work that is over and above the usual procedure. It is not appropriate to report a flap/graft from the Integumentary System for this technique.

This CPT Assistant prohibits reporting 15740 and 14040 with 64721. Is there a subsequent CPT Assistant pertaining to this situation?
 
It looks like as of March 2021, CPT Assistant has changed their stance on coding hypothenar flap with CTR. See below:

Question:

A patient is having an open revision carpal tunnel release in which a portion of the hypothenar fat flap was freed and transferred into the carpal tunnel. Is it appropriate to report code 64721 for carpal tunnel release and code 14040 for the additional work of the fat flap transfer?

Answer:

The work to free and transfer the hypothenar fat flap is not included in the typical work of a carpal tunnel release. When a hypothenar fat flap is performed without dissection of a named vessel included in the tissue transfer, report code 14040, Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less, in addition to code 64721, Neuroplasty and/or transposition; median nerve at carpal tunnel, for the open carpal tunnel release.

If the surgeon performs a dissection of feeder artery branches that come from the ulnar artery (defined as beyond third order in Appendix L of the CPT code set) and these vessels are included in the tissue transfer, then the appropriate codes to report for the procedure are codes 15740, Flap; island pedicle requiring identification and dissection of an anatomically named axial vessel, and 64721. Note the additional dissection must be documented in the operative report.

Carpal tunnel release with hypothenar fat flap freed and transferred into the carpal tunnel
CPT Assistant, March 2021 Page: 9 Category: Frequently Asked Questions
 
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