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Thread: Please help with this 64721 + ???

  1. #1
    Join Date
    Apr 2007
    Pensacola , Florida

    Default Please help with this 64721 + ???

    AAPC: Back to School
    I have 64721 but is there anything else I can bill considering the additional scar tissue ( I can't find anything ) but want to be sure ...

    Pt had previous CPR only 5 months ago where numbness and tingling have returned

    DESCRIPTION OF CASE: The patient was given an outpatient brief general anesthesia by ... and prepped and draped in the usual fashion with double Betadine prep, double drape throughout. A 1 g of Kefzol was given prior to tourniquet inflation. Total tourniquet time was 19 minutes.

    Very careful and detailed dissection down to the area of the transverse carpal ligament was accomplished knowing very well that the prior surgical scarring would have disturbed some of pristine anatomy.

    Transverse carpal tunnel was released both proximally and distally along the ulnar border very carefully to avoid any entanglement with the median nerve which may have scarred up underneath it.

    It was only found to be present in one spot that was approximately in the middle. There was a large portion of scar tissue.

    We were then able to separate the transverse carpal ligament reconnection from the median nerve proper under direct visualization.

    As I stated very careful tedious dissection was utilized.

    The patient then had what I thought was an area of scar tissue around the paratenon. It was released. Essentially, the backside of the nerve was not approached because I thought it would tether the nerve.

    Once the scarring was released in the area of the nerve, it looked to be free in about 270 degrees of its circumference both proximally and distally.
    At this point, a careful inspection for the third time was accomplished to make sure that there was a release which was complete both proximally and distally and with the microhemostat.

    There was no further encumberment found.

    As I stated a free graft was placed into the wound which had been previously harvested and then 3-0 horizontal mattress sutures of Prolene were utilized. None of the deep structures were of course closed.

    There was nice covering of fat or adipose tissue over the area of the incision and what I hope it would block any recurrence.

    Oh and the dx is : recurrent carpal tunnel disease as evidenced by provocative test EMG and clinical course ... this would still be 354.0 right ?

    Thank you !!!
    Last edited by Justarose; 03-19-2009 at 07:59 PM. Reason: dx question

  2. #2
    Join Date
    Apr 2007


    of course you will need a little more info from surgeon, but done forget the graft. You need some documentation about the harvest though.

    "As I stated a free graft was placed into the wound which had been previously harvested"

    Good luck
    Mary, CPC, COSC

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