How To Use CPT Code 64718

CPT 64718 refers to a neuroplasty and/or transposition procedure performed on the ulnar nerve at the elbow. 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 64718 procedures.

1. What is CPT 64718?

CPT 64718 is a medical procedure code used to describe a neuroplasty and/or transposition of the ulnar nerve at the elbow. This surgical procedure is performed to relieve pressure on the ulnar nerve, which can be caused by injury, swelling, or other sources of compression within the joint.

2. 64718 CPT code description

The official description of CPT code 64718 is: “Neuroplasty and/or transposition; ulnar nerve at elbow.”

3. Procedure

The 64718 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision into the target site in the patient’s elbow where the compressed ulnar nerve is present.
3. The compressed nerve is located, and external neurolysis is performed by cutting down the surrounding scar and soft tissues without entering into the nerve.
4. Any bone spur or damaged muscle putting pressure on the nerve may be removed.
5. If there is compression of the ulnar nerve at the elbow, a nerve transposition is performed, moving the ulnar nerve from behind the medial epicondyle to another position where it is not irritated or pinched.
6. The incision is closed in layers once the nerve has been repaired and freed.

4. Qualifying circumstances

Patients eligible to receive CPT code 64718 services are those experiencing symptoms of ulnar nerve compression at the elbow, such as pain, numbness, tingling, or weakness in the hand or forearm. These symptoms may be caused by various factors, including injury, inflammation, or the presence of scar tissue or bone spurs. A thorough examination and diagnostic testing, such as nerve conduction studies or electromyography, may be required to confirm the diagnosis and determine the need for surgical intervention.

5. When to use CPT code 64718

It is appropriate to bill the 64718 CPT code when a provider performs a neuroplasty and/or transposition of the ulnar nerve at the elbow to relieve pressure on the nerve and alleviate the patient’s symptoms. This code should be used only when the procedure is performed using an open surgical approach and not for minimally invasive or endoscopic techniques.

6. Documentation requirements

To support a claim for CPT 64718, the following information should be documented in the patient’s medical record:

• A detailed history and physical examination, including the patient’s symptoms and any relevant diagnostic test results.
• A clear description of the surgical procedure performed, including the incision site, steps taken to release the nerve, and any additional procedures performed, such as bone spur removal or nerve transposition.
• Postoperative care instructions and follow-up plans, including any necessary rehabilitation or physical therapy.
• Documentation of the patient’s response to the procedure and any improvements in symptoms or function.

7. Billing guidelines

When billing for CPT code 64718, it is essential to follow the appropriate guidelines and rules to ensure accurate reimbursement. Some tips and codes that apply to CPT code 64718 include:

• Ensure that the patient’s diagnosis supports the need for the procedure and that all necessary documentation is included in the medical record.
• Use the appropriate modifiers, if necessary, to indicate any special circumstances related to the procedure, such as bilateral procedures or staged procedures.
• Be aware of any payer-specific guidelines or requirements related to billing for CPT code 64718, as these may vary between insurance carriers.

8. Historical information

CPT 64718 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 64718

Five similar codes to CPT 64718 and how they differ are:

• CPT 64716: This code refers to a neuroplasty and/or transposition of the ulnar nerve at the wrist, rather than at the elbow.
• CPT 64719: This code is used for neuroplasty and/or transposition of the median nerve at the elbow or forearm, not the ulnar nerve.
• CPT 64721: This code describes a carpal tunnel release procedure, which involves the median nerve at the wrist, not the ulnar nerve at the elbow.
• CPT 64722: This code is for neuroplasty and/or transposition of the digital nerve, not the ulnar nerve at the elbow.
• CPT 64727: This code refers to an internal neurolysis procedure, which involves entering the nerve, unlike the external neurolysis performed in CPT 64718.

10. Examples

Here are 10 detailed examples of CPT code 64718 procedures:

1. A patient with a history of elbow trauma presents with persistent pain and numbness in the hand and forearm. Diagnostic testing confirms ulnar nerve compression at the elbow, and the provider performs a neuroplasty and transposition of the ulnar nerve.
2. A patient with cubital tunnel syndrome undergoes an open surgical procedure to release the ulnar nerve at the elbow and transpose it to a new position to alleviate symptoms.
3. A patient with a bone spur causing ulnar nerve compression at the elbow undergoes a neuroplasty procedure to remove the bone spur and release the nerve.
4. A patient with a history of elbow surgery develops scar tissue that compresses the ulnar nerve. The provider performs a neuroplasty to release the nerve and alleviate symptoms.
5. A patient with chronic elbow inflammation and ulnar nerve compression undergoes a neuroplasty and transposition procedure to relieve pressure on the nerve and improve function.
6. A patient with a congenital elbow deformity experiences ulnar nerve compression and undergoes a neuroplasty and transposition procedure to correct the issue.
7. A patient with a history of repetitive elbow strain develops ulnar nerve compression and undergoes a neuroplasty procedure to release the nerve and alleviate symptoms.
8. A patient with a tumor causing ulnar nerve compression at the elbow undergoes a neuroplasty procedure to remove the tumor and release the nerve.
9. A patient with a history of elbow dislocation experiences ulnar nerve compression and undergoes a neuroplasty and transposition procedure to correct the issue.
10. A patient with a chronic elbow infection develops ulnar nerve compression and undergoes a neuroplasty procedure to release the nerve and alleviate symptoms.