By Daniel J. Nagle, MD
Chair, ASSH Coding and Physician Reimbursement Committee
Use of 64718 with 24305
In spite of my efforts to be clear in the May Coding Corner, there lingers some confusion regarding the use of 64718 (Neuroplasty and/or transposition; ulnar nerve at elbow) with 24305 (Tendon lengthening, upper arm or elbow, each tendon).
64718 and 24305-59 should be used when coding for a submuscular transposition of the ulnar nerve at the elbow that is performed with a lengthening of the flexor/pronator tendon/muscles. The procedure section of the operative report should read:
Neuroplasty and transposition of the ulnar nerve at the elbow for cubital tunnel syndrome and tendon lengthening of the flexor pronator muscles at the elbow.
The inclusion of “for cubital tunnel syndrome” in the procedure section of the operative report clearly indicates to all who read it that the primary procedure is 64718. Also, I would not recommend using the word “submuscular” as there is no code for a “submuscular” ulnar nerve transposition. The 64718 / 24305-59 code pair should not be used for an intramuscular ulnar nerve transposition or medial epicondylectomy.
I hope this clarifies the use of these two codes. Sorry for any confusion caused by the May Coding Corner.
Dan Nagle