How To Use CPT Code 29848

CPT 29848 is an endoscopic procedure for treating carpal tunnel syndrome by releasing the transverse carpal ligament. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 29848 procedures.

1. What is CPT 29848?

CPT 29848 is a surgical code used to describe an endoscopic procedure for treating carpal tunnel syndrome. The procedure involves the release of the transverse carpal ligament to reduce compression on the median nerve in the carpal tunnel, which results in pain and numbness. This code is specifically for endoscopic procedures, and other codes should be used for open repairs or other related procedures.

2. 29848 CPT code description

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

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. The provider makes a small incision in the wrist area.
3. An endoscope is inserted through the incision into the wrist joint.
4. Saline solution is instilled to expand the area around the wrist joint.
5. The provider views the entire joint area using the camera of the scope and identifies the transverse carpal ligament.
6. The ligament is divided to release the pressure on the median nerve and tendons in the carpal tunnel.
7. The area is irrigated, checked for bleeding, and any instruments are removed.
8. The incision is closed.

4. Qualifying circumstances

Patients eligible to receive CPT code 29848 services are those diagnosed with carpal tunnel syndrome and experiencing symptoms such as pain, numbness, and weakness in the hand and wrist. The endoscopic procedure is typically recommended for patients who have not responded to conservative treatments, such as splinting, anti-inflammatory medications, or corticosteroid injections. A thorough evaluation of the patient’s medical history, physical examination, and diagnostic tests, such as nerve conduction studies and electromyography, should be performed to confirm the diagnosis and determine the appropriateness of the endoscopic procedure.

5. When to use CPT code 29848

It is appropriate to bill the 29848 CPT code when the provider performs an endoscopic release of the transverse carpal ligament to treat carpal tunnel syndrome. This code should not be used for open repairs or other related procedures, as different codes apply to those situations.

6. Documentation requirements

To support a claim for CPT 29848, the following information should be documented in the patient’s medical record:

• Patient’s medical history, including symptoms and duration of carpal tunnel syndrome
• Physical examination findings, such as Tinel’s sign, Phalen’s test, or other relevant tests
• Diagnostic test results, including nerve conduction studies and electromyography
• Conservative treatments attempted and their outcomes
• Indication for the endoscopic procedure
• Details of the procedure, including anesthesia, incision, endoscope insertion, ligament identification and release, and closure
• Postoperative care instructions and follow-up plan

7. Billing guidelines

When billing for CPT code 29848, it is essential to follow the specific guidelines and rules set by the payer. Some payers may require preauthorization for the procedure, while others may have specific documentation requirements. Additionally, be aware of any applicable modifiers, such as -50 for bilateral procedures or -59 for distinct procedural services, and use them as needed. It is also important to note that CPT 29848 should not be reported in conjunction with 11960, and for open procedures, use 64721 instead.

8. Historical information

CPT 29848 was added to the Current Procedural Terminology system on January 1, 1992. There have been no updates to the code since its addition.

9. Similar codes to CPT 29848

Five similar codes to CPT 29848 and how they differentiate are:

1. CPT 64721: This code is used for open repair of carpal tunnel syndrome, involving neuroplasty and/or transposition of the median nerve at the carpal tunnel.
2. CPT 64719: This code is used for neuroplasty and/or transposition of the ulnar nerve at the wrist, which may be performed during the same open session as CPT 64721.
3. CPT 29846: This code is used for endoscopic wrist procedures involving debridement and/or synovectomy.
4. CPT 29847: This code is used for endoscopic wrist procedures involving arthroplasty.
5. CPT 11960: This code is used for the insertion of a subcutaneous implant in the arm, which should not be reported in conjunction with CPT 29848.

10. Examples

Here are 10 detailed examples of CPT code 29848 procedures:

1. A patient with a history of carpal tunnel syndrome and failed conservative treatments undergoes an endoscopic release of the transverse carpal ligament.
2. An endoscopic carpal tunnel release is performed on a patient with severe carpal tunnel syndrome and significant functional impairment.
3. A patient with persistent carpal tunnel syndrome symptoms despite corticosteroid injections undergoes an endoscopic release of the transverse carpal ligament.
4. An endoscopic carpal tunnel release is performed bilaterally on a patient with bilateral carpal tunnel syndrome.
5. A patient with carpal tunnel syndrome and a positive Tinel’s sign undergoes an endoscopic release of the transverse carpal ligament.
6. An endoscopic carpal tunnel release is performed on a patient with carpal tunnel syndrome and a positive Phalen’s test.
7. A patient with carpal tunnel syndrome and abnormal nerve conduction study results undergoes an endoscopic release of the transverse carpal ligament.
8. An endoscopic carpal tunnel release is performed on a patient with carpal tunnel syndrome and a history of wrist trauma.
9. A patient with carpal tunnel syndrome and a positive electromyography result undergoes an endoscopic release of the transverse carpal ligament.
10. An endoscopic carpal tunnel release is performed on a patient with carpal tunnel syndrome and a history of repetitive wrist strain.