Carpal Tunnel Release CPT

Carpal Tunnel Release CPT Code (2022) Description, Guidelines, Reimbursement, Modifiers & Example

Carpal Tunnel Release CPT code is 64721 and 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.

Carpal Tunnel Release CPT 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 for freeing the nerve. While CPT 64719 will be reported when the ulnar nerve is freed.

The sutured will be applied in layers to the incision site after freeing the nerve, and the physician will provide 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 transverse carpal ligament is released by placing the patient in a supine position with the arm positioned 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. These two incisions will be closed by the sutures after removing instruments from the portal, 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 weakening the muscles
  • Symptoms of pain are longer than the 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, the median nerve at the carpal tunnel

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

  • Endoscopy, Wrist, Surgical, with the release of carpal ligament. 

Suppose both open procedure and endoscopic surgical procedure are done on the same day by the same physician. In that case, it is appropriate to add a modifier with CPT 29848 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

Modifiers 

The following list is of modifiers that are applicable with CPT codes (29848, or 64721):

  • 23, 22, 47, 50, 51, 52, 53, 55, 54, 56, 58, 59, 63, 76, 77, 78, 79, 99, AI, AQ, AR, CC, CR, EY, ET, GA, GC, GJ, GK, GR, GU, GY, GZ, KX, LT, PT, QJ, Q5, Q6, RT, SG, XE, XP, XU, XS

Modifier 47 will be appended with CPT 64721, or 29848 if anesthesia is given by an assistant or attending surgeon. 

Modifier 59 is applicable with CPT 64721, or 29848. If any other procedure is done in combination with these services that are not normally billed together on the same date of service, then modifier 59 will be appropriate. At the same time, modifier 51 is applicable when the other procedure is not the component of CPT 64721 or 29848. 

Modifier 23 is applicable with CPT code 64721, or 29848 if general or local anesthesia is given to patients who are normally not required for the procedure. 

Modifier 76 will be attached to CPT 64721, or 29848 if the same physician repeats service on the same service date, while modifier 77 if the procedure has been done on the same date service by a different physician respectively.

Modifier 78 will be appended with CPT 64721, or 29848 if the procedure is repeated with the same condition of the global period. In contrast, modifier 79 is applicable when the procedure is reported for an unrelated condition.

cpt carpal tunnel release

Billing & Coding Guidelines

CPT 29848 and Carpal Tunnel Release CPT 64721 are allowed to bill together on the same date of service, 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 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 is allowed to 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 also 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. 

Carpal Tunnel Release CPT Examples

Below are examples of when Carpal Tunnel Release CPT 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 now 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 for a longer time. The physician has completed the review of 10 organ systems. Overall, the patient seems well and has no dietary issues. Physical exam revealed swelling in the right upper limb with severe pain, the median nerve was decompressed, and no medication contributed to relief in the pain.

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. 

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 pains injection for pain relief, but it was effective 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 with applying pressure.

The physician ordered diagnostic tests like LABS, Radiology test CT, MRI, 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 suggests the arthroscopic procedure of Carpel tunnel release of both hands. 

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 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, then it will be reported with Carpal Tunnel Release CPT 64721.

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