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.