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Coding help again, please!

  1. Default Coding help again, please!
    Medical Coding Books

    I need verification on the codes I am thinking would be correct to code the following op note. I am thinking CPT 64721 for the carpal tunnel release & CPT 29999 for the endoscopic cubital tunnel release. Please let me know if you agree this would be the correct way to code this:

    SURGICAL PROCEDURE: Right endoscopic cubital tunnel release and right carpal tunnel release.

    DESCRIPTION OF PROCEDURE: The patient was brought to the Operative Suite. After armband identification, verification of the side and site of surgery, the left upper extremity was prepped and draped in a standard surgical fashion and the tourniquet was utilized at 250 mmHg for a total of 10 minutes. Incision was made over the ulnar nerve at the medial aspect of the elbow. Dissection was carried out bluntly with tenotomy scissors and retractors. The ulnar nerve was then identified. The Osborne's fascia was incised longitudinally and utilizing a blunt dissection superficially to avoid crossing the antebrachial and brachial nerves. The superficial tissues were dissected proximal-ward and distal-ward. Attention was then turned to the cubital tunnel itself in the Osborne's fascia, utilizing the Integra endoscopic cubital tunnel system an obturator was placed into the cubital tunnel, the arthroscopic guide was then utilized over the top visualization to ensure no crossing vessels or nerves. The push cut knife was then used to endoscopically release the fascia overlying the ulnar nerve distal-ward and proximal-ward. At the completion of this, the tourniquet was let down. Hemostasis was obtained with a bipolar electrocautery. Subcuticular closure with 4-0 Monocryl. Steri-Strips and Angiocath 14-gauge were placed prior to wound closure and 10 mL of Marcaine 0.5% with epinephrine were injected. Soft dressings with an Ace wrap were applied. Sponge, instrument, and needle count were verified and correct x2 at the end of the case.

    Incision was made in the thenar crease with a #15 blade scalpel. Dissection was carried out sharply with a #15 blade scalpel. The palmar fascia was incised longitudinally with a #15 blade scalpel. Heiss retractors and Ragnell retractor were utilized for exposure. The transverse carpal ligament was identified and released with a #15 blade scalpel. Median nerve was found to be hyperemic upon release of the transverse carpal ligament. Motor branch was identified and protected throughout the remainder of the case. The proximal dissection was performed utilizing curved Mayo scissors into the volar forearm fascia. Attention was then turned distal and superficial palmar arch was identified and protected and the distal leading edge of the transverse carpal ligament was released utilizing tenotomy scissors. The tourniquet was let down. Hemostasis was obtained. The wound was copiously irrigated. The skin was closed with 4-0 nylon horizontal mattress sutures. Xeroform, 4 x 4 gauze, splint and ace-wrap was applied. Sponge, instrument, and needle counts were verified correct x2 at the end of the case. The patient tolerated the procedure well and transferred to the Post Anesthesia Care Unit and will begin hand therapy in three to five days, and will follow up in the office in two weeks for wound check or sooner as needed.

    Thanks so much!!

  2. #2
    I would agree with your choices; compare 29999 to 64718.
    Natalie Eichholzer, CPC, CPC I, CUC
    2017 Chapter Secretary
    AAPC Frankfort, IL Chapter

  3. Default
    Thank you so much for your help, Natalie!! I really appreciate it!!


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