Currently there are two major approaches to surgical treatment of carpal tunnel syndrome. Code 64721 neuroplasty and/or transposition; median nerve at carpal tunnel (includes external neurolysis) this code is used for the open approach. Code +64721 Internal neurolysis, requiring use of operating microscope (list separately in addition to code for neuroplasty). The coder must be aware that this is an add-on code and can never be submitted as the only code on the claim describe open surgical procedures.
Code +64721 can only be used if documentation support that a neurolysis was done using the operating microscope.
CPT code +69990 Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure) cannot be used with 64721.
Endoscopic surgical treatment of CTS is reported 29848 Endoscopy, wrist, surgical, with release of transverse carpal ligament.
When reporting any of the aforementioned surgical codes, remember to apply modifiers LT Left side, RT Right side and 50 Bilateral procedure, as circumstances require. Some insurance carriers may require the use of the codes twice with or without the appropriate modifier. Check with your carrier/fiscal intermediary for the proper billing instructions
Patients that have had previous carpal tunnel repairs can have their surgery re-done if the symptoms are not relieved. In this case, the coder may use the same CPT code that was used for the original repair.
Mary D. Gregory, RHIT, CCS, CPC, CPC-I, CCS-P, is the founder of Medical Administrative Solutions (MAS, www.mascodingsolutions.com), a healthcare consulting firm specializing in medical coding, billing, reimbursement, compliance and training solutions. She has 20-plus years of medical experience in inpatient and outpatient services. She is also a licensed professional medical coding curriculum (PMCC) instructor.