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Basics about CPT code 64721 for Carpal Tunnel Release

A very common disorder of wrist is Carpal tunnel syndrome. In this procedure, the medial nerve is released which is decompressed. The medial nerve is located in wrist and is solely responsible for carpal tunnel syndrome. The CPT codes are based on decompressed nerve. We have separate CPT code for Carpal tunnel release for ulnar and medial nerve. As we use CPT code 64721 for medial nerve release, there is a separate code for ulnar nerve release, CPT code 64719. In both procedures, the soft tissues are resected to access the nerve and the decompressed nerve is freed from the underlying bed. Precautions are taken to ensure the tension is released and the incisions are sutured in layers. Below is the code description for CPT code 64721.

64721 – Neuroplasty and/or transposition; median nerve at carpal tunnel

ICD 10 code for CPT code 64721 for Carpal Tunnel Syndrome

The physician decompresses or transposes a portion of the ulnar or median nerve to restore feeling to the hand. The physician makes a horizontal incision in the wrist at the metacarpal joints and locates the nerve. In 64719, the ulnar nerve is located and freed. In CPT code 64721, the median nerve is decompressed by freeing the nerve inside the carpal tunnel. Soft tissues are resected and the nerve is freed from the underlying bed. Care is taken to ensure tension is released and the incision is sutured in layers.

Since, we have now familiar with CPT code for Carpal Tunnel release, now will check the diagnosis codes. We have a direct ICD 9 diagnosis code for Carpal tunnel syndrome, 354.0. However, in ICD 10 we have specific code for right, left, bilateral or unspecified side of limb. So, if only carpal tunnel syndrome is mention without specifying the side, we will code unspecified G56.00 as ICD 10 code for carpal tunnel syndrome.

ICD 9 code for Carpal tunnel syndrome
354.0

ICD 10 code for Carpal tunnel syndrome unspecified
G56.00 Carpal tunnel syndrome, unspecified upper limb

G56.01 carpal tunnel syndrome, right upper limb

G56.02 carpal tunnel syndrome, left upper limb

Pain in Forearm ICD 10 codes can also be used

M79.631, pain in right forearm

M79.632, pain in left forearm

M79.639, pain in unspecified forearm

Coding tips for Tunneled Catheter exchange CPT codes

Procedure performed for CPT code 64721

In this exam, patient’s arm is placed on the hand surgery table. Indicate the areas of the skin to be prepped and mark the surgical incisions. Apply a tourniquet to the proximal arm. Prep and drape the arm and hand. Elevate and exsanguinate the arm. Inflate the pneumatic tourniquet. Scrub and gown. Perform a surgical time out with the operating surgical team.

Make an incision along the ulnar border of the carpal tunnel in the palm. Carry out careful dissection. Identify and protect the branches of the palmar cutaneous branch of the median nerve, as well as the palmar cutaneous branch of the ulnar nerve. Identify the transverse carpal ligament. Identify the proximal and distal edges of the transverse carpal ligament. Place a groove director in the carpal tunnel along its ulnar border. Use a #15-blade to incise the transverse carpal ligament along its ulnar border. Take care not to injure the underlying flexor tendons or the branches of the median or ulnar nerve.

Take care to protect the superficial palmar arch and the communicating sensory branches between the median and ulnar nerves, which course just distal to the transverse carpal ligament. Once the transverse carpal ligament is released, examine the contents of the carpal tunnel, including the flexor tendons and the median nerve. If needed, carry out an external neurolysis of the median nerve. Thoroughly irrigate the wound. Approximate the skin with an interrupted suture.

Coding guide for ORIF distal radius CPT codes

Supply Codes with CPT code 64721

SB044 underpad 2ft x 3ft (Chux)
SA048 pack, minimum multi-specialty visit
SA054 pack, post-op incision care (suture)
SG017 bandage, Kling, non-sterile 2in

Includes and Excludes with CPT code 64721 for Carpal Tunnel Syndrome

Repair of medial nerve or Neuroplasty includes external neurolysis and transposition. For performing internal neurolysis, operating microscope is used; use CPT code 64727 in addition with the primary procedure.

For endoscopically performed procedure for carpal tunnel release, do report CPT code 29848. Do not use CPT code 64721 for endoscopically performed carpal tunnel release.

29848 – Endoscopy, wrist, surgical, with release of transverse carpal ligament

For facial nerve decompression, do use CPT code 69720.

Few similar CPT code like carpal tunnel release you can check below.

CPT code 26055 Tendon sheath incision (eg, for trigger finger release)

General information for CPT code 64721 for Carpal Tunnel Syndrome

                                                                                         Global
Work RVU/Base Units:                                              4.97
Non Facility Practice Expense RVU:                     7.50
Facility Practice Expense RVU:                                7.26
Professional Liability Insurance RVU:                   0.97
Non Facility Total RVU:                                            13.44
Facility Total RVU:                                                     13.20
Medicare Non Facility National Payment:             $455.44
Medicare Facility National Payment:                      $447.31
Medicare Status*:                                                        A
Medicare Policy Indicators*:                                    A B M

Other related CPT codes for Neuroplasty |CPT code 64721

Finally, I hope after reading this article you will confidently code CPT code for carpal tunnel release and ICD 9 and ICD 10 for carpal tunnel syndrome. Do share this article if you find it helpful.

CPT code 64721 coding tips for Carpal tunnel release