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Thread: Ulnar Nerve Decompression w/ flexor orgin slide

  1. #1

    Default Ulnar Nerve Decompression w/ flexor orgin slide

    AAPC: Back to School
    Has anymore come across these two codes being bundled? My physican is using 25315 and 64718 together stating they are separate procedures. We have previously billed out with a 59 modifier, however CCI and McKesson edits bundle them. Below is the operative note, is it distinguishable:

    DESCRIPTION OF PROCEDURE: A curvilinear incision in the postcondylar groove of the medial aspect of the right elbow was created. Dissection was carried through the subcutaneous tissue. The medial brachial and antebrachial cutaneous nerves were identified and protected. The ulnar nerve was identified. The ulnar nerve was completely decompressed from 10 to 15 cm proximal to the elbow and into the flexor carpi ulnaris musculature. Once the nerve was completely decompressed, it could be elevated out of the postcondylar groove. The nerve was very healthy appearing until approximately 12 cm before the cubital tunnel. Within the cubital tunnel, the nerve was discolored. It was flattened and also torsed. Into the flexor carpi ulnaris it remained discolored until approximately 10 cm distal to the cubital tunnel at which time it became much more normal appearing. A subcutaneous flap was elevated anteriorly. A stepwise incision was performed within the flexor pronator mass. The flexor pronator mass was divided in its entirety. The medial intermuscular septum was cauterized and a 2- to 3-cm segment was removed down to the humerus. The fascial edge of the insertion of the flexor carpi ulnaris was divided and removed. At this point, the ulnar nerve could be laid upon the brachialis muscle. The musculofascial slide procedure was repaired in the advanced position using 3-0 Ethibond suture. There were absolutely no sites of compression either proximally or distally. The nerve glided very well with flexion and extension of the elbow with no sites of impingement. The wound was irrigated with sterile saline.

    If anyone can help please let me know...

  2. #2
    Join Date
    Apr 2007
    Greater Pittsburgh


    I agree that it is included, the lay description for 25315 states; 'Neurolysis of the median and ulnar nerves is performed.' and it is included in the CCI edits.

    If your physician thinks he did over and above, you might try -22 modifier with an explanation (letter) from the Dr.
    jdemar, CPC, CMA

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