Carpal Tunnel Release CPT Code (2023) | Description, Guidelines, Reimbursement & Examples

Carpal Tunnel Release CPT code is 64721 and is used to report services when an open procedure is performed to release the median (carpal tunnel) nerve and alleviate pain by freeing tissues surrounding the nerve. CPT 64719 is used when the ulnar nerve is freed, and you can use CPT 29848 when the provider performs endoscopic surgery for carpal tunnel syndrome.

Carpal Tunnel Release | CPT Code Description 

The median or ulnar nerve is transposed or decompressed by the physician to relieve pain and restore the feelings of the hand. The physician makes the horizontal incision to locate the nerve in the wrist at the metacarpal joints to release the pressure on the nerve and relieve the pain.

Carpal Tunnel Release CPT 64721 is used to report when the procedure is performed to decompress the median nerve inside the carpal tunnel to free the nerve. While CPT 64719 will be reported when the ulnar nerve is freed.

The official description of CPT code 64721 is: “Neuroplasty and/or transposition; median nerve at the carpal tunnel.”

The official description of CPT code 64719 is: “Neuroplasty and/or transposition; ulnar nerve at wrist.”

The suture will be applied in layers to the incision site after freeing the nerve, and the physician will provide the necessary care to release the pressure at the carpal tunnel.

CPT 29848 will be reported when endoscopic surgery is performed for carpal tunnel syndrome.

The official description of CPT code 29848 is: “Endoscopy, wrist, surgical, with release of transverse carpal ligament.”

Endoscopic Release Of Carpal Tunnel Techniques

The transverse carpal ligament is released by placing the patient supine with the arm on the hand table. There are two types of techniques available when the endoscopic release of carpal tunnel is performed, which are as follows:

Single Portal Technique: A small horizontal incision is made at the wrist, approximately 1 1/2 cm in size.

Two Portal Technique: The two small incisions are made at the wrist and palm. The skin of the palm, protective fascia muscle, and cushioning fat are not cut. The endoscope is inserted underneath the transverse carpal tunnel ligament, which aids the physician in viewing the procedure on a monitor.

A blade is embedded in the arthroscope that helps to make the incisions at the transverse carpal tunnel ligament from the inside of the carpal tunnel. After removing instruments from the portal, the sutures will close these two incisions, and a splint may be applied.

The following reasons are when a physician suggests Carpal Tunnel Release CPT surgery:

  • Pain is not relieved by the Non-surgical interventions
  • When carpal tunnel syndrome diagnosed after electromyography tests
  • Compression of median nerves causes pain and weakens the muscles.
  • Symptoms of pain are longer than six months without any relief.
  • Tingling, pain, numbness, weakness, and difficulty in movement of hands

Carpal Tunnel Release CPT 64721 will be reported for services when a physician performs neuroplasty and/or transposition of the median nerve at the carpal tunnel

While an endoscopic, open procedure releases the Carpal tunnel, CPT 29848 will be reported.

Suppose both open and endoscopic procedures are done on the same day by the same physician. Adding a modifier with CPT 29848 is appropriate in that case, according to the NCCI (National Correct Coding Initiative).

cpt code for carpal tunnel release

Reimbursement

The cost and RUVS of CPT 64721 are as follows:

  • Facility: Cost 491.23$ RUVS 14.19474
  • Non-Facility: Cost 501.39$ RUVS 14.48849

If the Carpal tunnel release procedure is done by endoscopy (CPT 29848), then the cost and RUVS of the CPT code are as follows:

  • Facility: Cost 572.62$ RUVS 16.5487
  • Non-Facility: Cost 572.62$ RUVS 16.5487

Billing & Coding Guidelines

CPT 29848 and Carpal Tunnel Release CPT 64721 are allowed to bill together on the same service date, and the modifier is allowed according to NCCI. Modifier 59 will be attached to CPT 29848. 

If the ulnar nerve’s transposition or neuroplasty is performed, it will be reported with CPT 64719 instead of 64721.

If the transposition or Neuroplasty of Transverse carpal tunnel is performed by arthroscopy, then it will be reported with CPT 29848

If a tissue expander is incorporated other than the breast, subsequent expansion (CPT 11960) will not be reported with CPT 64721 or CPT 29848. CPT 11960 is included in Carpal Tunnel Release CPT 64721. Unless it is performed on different anatomical sites, it can bill together with the appropriate modifier.

CPT 64721 includes External neurolysis and/or transposition to repair or restore nerve, neuroplasty with nerve wrapping, Surgical decompression/freeing nerve from scar tissue

If the CPT 69721 Facial nerve decompression is performed in combination with CPT 64721, it is separately reportable without any modifier.

If Percutaneous neurolysis (62263-62264, 62280-62282) is performed in conjunction with CPT 64721, these CPTs are separately reportable with Carpal Tunnel Release CPT 64721 without appending any modifier.

If Casts and Strapping are applied in addition to CPT 64721, casts and strapping will be reported separately in the CPT book surgery section, Under the Musculoskeletal system.

ICD 10 codes should support the medical necessity of the documents and reflect the patient’s current condition to perform CPT 64721. The most used ICD Codes of CPT 64721 are M25.531, M25.532, M79.631, M79.632, G56.01, G56.02, etc.

Carpal Tunnel Release CPT 64721 or CPT 29848 has a global period of 90 days (about three months). All the evaluation and management services (99202-99499) will be included in the global period unless patients receive services for unrelated conditions; then, it will be appropriate to bill with global modifiers

Endoscopic Carpal Tunnel Release CPT Code

If an endoscope does carpal tunnel release surgery, this surgical procedure will be reported with CPT 29848.

Right Carpal Tunnel Release CPT Code  

Modifier RT will be appended with Carpal Tunnel Release CPT 64721, or 292848 if the Carpal tunnel release procedure is done on the right carpal tunnel wrist such as 64721-RT, M25.531, or 292848-RT, M25.531.

Left Carpal Tunnel Release CPT Code  

Modifier LT will be appended with Carpal Tunnel Release CPT 64721, or 292848 if the Carpal tunnel release procedure is done on the right carpal tunnel wrist, such as 64721-LT, M25.532, or 292848-LT, M25.532.

Open Carpal Tunnel Release CPT Code  

If carpal tunnel release is performed as an open surgical procedure, it will be reported with Carpal Tunnel Release CPT 64721.

Examples

Below are billing examples of when Carpal Tunnel Release CPT codes 64721 or CPT 29848 is performed.

Example 1

A 35-year-old male presents to the emergency department with a status post right wrist fracture about six months ago and has continued pain in the right wrist for 1 to 3 months. Pain is 10 out of 10 in severity. The patient did take Tylenol for pain relief, but it gives pain relief for 1 to 2 hours.

He has also pinched and numbness in his right hand and cannot hold anything longer. The physician has completed the review of 10 organ systems. Overall, the patient seems well and has no dietary issues. A physical exam revealed swelling in the right upper limb with severe pain, the median nerve was decompressed, and no medication contributed to the pain relief.

Physicians ordered CT, MRI, and Doppler Venous ultrasound to diagnose the problem triggering the pain in the right upper limb. Diagnostic tests revealed that the patient has carpal tunnel syndrome. The physician suggests the patient have Carpel tunnel release surgery.

Otherwise, symptoms will get worse as time passes on. The physician scheduled an appointment with an orthopedic surgeon for further discussion. 

Billing:

CPT Codes:

  • CPT 99285: Emergency department visit for the evaluation and management of a patient, which requires significant physician work and is of high complexity: This code is used for the emergency department visit to evaluate and manage the patient’s right wrist pain and other symptoms.
  • CPT 64721: Neuroplasty and/or transposition; median nerve at carpal tunnel: This code represents the decompression of the median nerve performed during the physical examination.
  • CPT 29826: Arthroscopy, wrist, surgical; with release of transverse carpal ligament: This code represents the carpal tunnel release surgery suggested by the physician.

ICD-10 Codes:

  • ICD 10 S62.309A: Fracture of unspecified carpal bone, unspecified wrist, initial encounter for closed fracture: This code is used to document the patient’s history of a right wrist fracture.
  • ICD 10 G56.01: Carpal tunnel syndrome, right upper limb: This code is used to document the diagnosis of carpal tunnel syndrome in the right upper limb.

Modifiers:

  • Modifier 25: Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service: This modifier indicates that the evaluation and management service provided is significant and separate from the carpal tunnel release surgery.

Example 2

A 39-year-old female presented to the emergency department with no past medical and family history and is now with tingling, numbness, and pinching in both hands for 15 days. Pain is getting sware with the movement of hands and unable to hold anything.

The patient did receive a pain injection for pain relief, but it was adequate for a limited time. The 10 points of review of systems were completed and reviewed. Physical exams revealed that the patient has erythema of both upper extremities, swelling, and pain when applying pressure.

The physician ordered diagnostic tests like LABS, Radiology test CT, MRI, and US Doppler of both upper extremities o confirm the patient’s condition. The studies revealed that the patient has compressed transverse carpal ligaments and needs a decompression procedure to release that nerve for pain relief.

An orthopedic appointment was scheduled for the patient, and he suggested the arthroscopic procedure of Carpel tunnel release of both hands. 

Billing:

CPT Codes:

  • CPT 99284: Emergency department visit for the evaluation and management of a patient: This code is used for the patient’s presentation to the emergency department with tingling, numbness, and pinching in both hands.
  • CPT 72141: Magnetic resonance (e.g., MRI), cervical spine; without contrast material: This diagnostic test is ordered to evaluate potential cervical spine issues related to the patient’s hand symptoms.
  • CPT 73221: Magnetic resonance (e.g., MRI), upper extremity, other than the joint, without contrast material: This diagnostic test is ordered to assess the patient’s upper extremities for any abnormalities.
  • CPT 93922: Noninvasive physiologic studies of upper or lower extremity arteries, bilateral: This diagnostic test is ordered to evaluate blood flow in the patient’s upper extremities.
  • CPT 64721: Neuroplasty and/or transposition; median nerve at the carpal tunnel: This code is used for the arthroscopic carpal tunnel release procedure suggested by the orthopedic specialist.

ICD-10 Codes:

  • ICD 10 G56.00: Carpal tunnel syndrome, unspecified upper limb: This code documents the patient’s carpal tunnel syndrome diagnosis in both hands.

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