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CPT 64718 & CPT 64719 | Descriptions, Reimbursement & Billing Guide

CPT code 64718 can be reported for neuroplasty and /or transposition, such as the ulnar nerve at the elbow. CPT code 64719 can be billed for neuroplasty and /or transposition, such as the ulnar nerve at the wrist. Below are the descriptions and billing guidelines.

What Is CPT Code 64718 & CPT Code 64719?

CPT code 64719 bills for the service when the physician performs a surgery on the elbow to remove tissue from around a nerve (ulnar nerve).

The physician decompresses a stressed ulnar nerve by freeing the nerve and the surrounding nerve tissue.

The physician makes an incision at the medial epicondyle. Then, it locates the nerve behind the medial epicondyle.

Then, the physician administers the patient’s general or regional anesthesia, dissects the surrounding tissues from the nerve, and frees the nerve from the underlying bed. 

The nerve is moved over the epicondyle to the front (anterior transposition) and stabilized with sutures in the surrounding tissue.

The physician then applies a cast or splint with the elbow bent at a 45-degree angle. Next, they place the nerve beneath the skin or a 90-degree arch within the muscle of the new location.

The cast remains in place for two to four weeks, allowing the incision to heal. Then, the patient will begin physical therapy for exercises that enable the patient to achieve full elbow function and help bring swelling down.

The physician decompresses or transposes a portion of the ulnar or median nerve to restore feeling to the hand in the cubital tunnel releasing during the 64719 CPT code procedure.

Next, the physician makes a horizontal incision in the wrist at the meta-ulnar joints and locates the nerve.

CPT code 64719 reports when the physician locates and releases the ulnar nerve. In contrast, CPT 64721 bills when they perform decompression procedures at the median nerve inside the cubital tunnel.

The physician resects the soft tissues and frees the nerve from the underlying bed. Then, it may perform to ensure tension is released and to apply sutures in the layers in the procedure described by the CPT code 64718.

The cubital tunnel syndrome, also referred to as cubital tunnel syndrome, is when the ulnar nerve becomes irritated or compressed, which may cause weakness, numbness, and forearm pain. To treat this, the physician may perform a procedure as described by CPT 64719.

TIP: If billing for carpel tunnel release on the median nerve, report CPT 64721. You can find the billing guide here.

The ulnar nerve is also a funny bone as it travels along the elbow’s inner (medial) bony part and, if bumped, can cause pain and brief numbness in the ring and tiny fingers.

The cubital nerve forms from joining several nerves in the neck and travels down the inside of the arm and elbow into the forearm toward the ring and tiny fingers. The physician may perform a the CPT 64719 procedure to decompress the ulnar nerve at the elbow region. 

Below you can find the three main reasons why a physician performs the procedure described by the 64719 CPT code:

  1. Partial or even complete numbness in the ring and tiny fingers.
  2. The clumsiness of the hand and difficulty with grip.
  3. More noticeable symptoms at night or while driving.

Description Of CPT Codes 64718 And 64719

CPT 64718 can be reported for the service when a physician performs neuroplasty and /or transposition, such as the ulnar nerve at the elbow.

CPT code 64718 is officially described by CPT’s manual as: “Neuroplasty and/or transposition; ulnar nerve at elbow.”

CPT 64719 can be reported for the service when the physician performs neuroplasty and /or transposition, such as the ulnar nerve at the wrists.

CPT code 64719 is officially described by CPT’s manual as: “Neuroplasty and/or transposition; ulnar nerve at wrist.”

How To Bill CPT 64718 And CPT 64719

Documentation must establish the medical necessity and appropriateness of CPT 64718 or CPT 64719 and reflect the patient health status and the severity of illness.

The CPT codes 64718 and 64719 have a 90-day global period, including a 1-day pre-operative period and a 90-day postoperative period.

External neurolysis and-/or transposition to repair or restore nerves is included, and it is inappropriate to report them separately. 

CPT code 64718 includes neuroplasty with nerve wrapping. It also included surgical decompression/freeing of the nerve from scar tissue. It is inappropriate to report them separately.

Neuroplasty is included in external neurolysis and transposition and can not be reported separately with CPT 64718 or CPT 64719.

It is appropriate to report with CPT 64719 instead of CPT code 64718 if the physician performs neuroplasty of the ulnar nerve at the wrist.

Can CPT 69720 And CPT 64718 Be Billed Together?

If the physician performs facial nerve decompression (CPT 69720) in combination with CPT code 64718, it is appropriate to report separately.

Can CPT 64727 Be Billed With CPT 64718 Or CPT 64719?

Suppose the physician performs internal neurolysis requiring an operating microscope. In that case, it is appropriate to report with CPT 64727 in addition to the code for the primary procedures CPT 64718 or CPT 64719. 

Can CPT 11960 Be Billed With CPT 64718 Or CPT 64719?

If the physician performs tissue expander insertion CPT 11960 in combination with CPT 64718 or CPT 64719, it is inappropriate to report separately.

Does CPT Code 64718 or 64719 A Modifier?

Modifier 52 applies with CPT 64718 or CPT 64719 when the physician terminates the procedure due to unavoidable circumstances.

For example: Suppose the physician terminates procedure CPT 64718 or CPT 64719 due to a rise in the patient’s temperature. If the physician does not schedule another procedure in the future, modifier 52 can be billed.

Modifier 53 is applicable when the physician terminates the procedure due to some unusual cause, such as shortness of breath. It may report after the administration of the anesthesia.

Modifier 47 will be appended when anesthesia administers by an assistant or attending surgeon, and modifier 23 can be reported if general or local anesthesia administers to patients who are usually not required for CPT code 64718 or 64719.

Modifier 51 attaches to the CPT 64718 or CPT 64719 when the physician performs a procedure, which is part of another service on the same date. 

Modifier 77 applies when the distinct physician performs a CPT 64718 or CPT 64719 procedure on the same day.

Modifier 76 will be attached to the 64718 CPT code or the 64719 CPT code if the same physician repeats one of these procedures on the same service date. 

Modifier 78 will be used with these CPT codes if the procedures are performed on the same service date and repeated with the exact condition in the global period. 

Modifier 79 can be billed when the procedure bills for an unrelated condition to the procedures performed on the same service date. Use modifier 22 when the physician spends more time on CPT 64718 or CPT 64719.

Reimbursement Of CPT 64718

A maximum of one unit can be a bill on the same service date of CPT 64718. In contrast, the two units allow when documentation supports the medical necessity of the cubital tunnel release at the elbow.  

The cost and RUVS of CPT 64718 are $673.49 and 19.46156 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 64718 are $673.49 and 19.46156 when performed in the non-facility.

Reimbursement Of CPT 64719

A maximum of one unit can be a bill on the same service date of CPT 64719. In contrast, the two units allow when documentation supports the medical necessity of the cubital tunnel release at the wrist.  

The cost and RUVS of CPT 64719 are $457.24 and 13.21271 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 64718 are $457.24 and 13.21271 when performed in the non-facility.

Example 1

A sixty-year-old female presents to the emergency department with no past medical or family history and has had tingling, numbness, and pinching in both hands for 20 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 physician reviews the ten systems. 

Physical exams revealed that the patient has erythema of both upper extremities, swelling, and pain with applying pressure. Therefore, the physician ordered diagnostic tests like labs, radiology test CT, MRI, and US doppler of both upper extremities to confirm the cubital tunnel release.

The studies revealed that the patient has compressed transverse ulnar ligaments and needs a decompression procedure to release that nerve for pain relief. The physician scheduled an orthopedic appointment for the patient and suggested the arthroscopic procedure of both hands for CPT code 64718 or 64719. 

If the physician performs the cubital tunnel release at the elbow region, it may bill with the 64718 CPT code. In contrast, CPT code 64719 reports for the cubital tunnel release at the wrist region.

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