Basics about CPT code for Carpal Tunnel Release

A very common disorder of wrist is Carpal tunnel syndrome.  In this procedure, the medial nerve is released which is decompressed. The medial nerve is located in wrist and is solely responsible for carpal tunnel syndrome. The CPT codes are based on decompressed nerve.  We have separate CPT code for Carpal tunnel release for ulnar and medial nerve. As we use CPT code 64721 for medial nerve release, there is a separate code for ulnar nerve release, CPT code 64719. In both procedures, the soft tissues are resected to access the nerve and the decompressed nerve is freed from the underlying bed. Precautions are taken to ensure the tension is released and the incisions are sutured in layers. Below is the code description for CPT code 64721.

64721 – Neuroplasty and/or transposition; median nerve at carpal tunnel

Coding tips for CPT code for Carpal tunnel release

Read also: Basic Difference between ICD 9 and ICD 10 codes

ICD 9 and ICD 10 code for Carpal Tunnel Syndrome

Since, we have now familiar with CPT code for Carpal Tunnel release, now will check the diagnosis codes. We have a direct ICD 9 diagnosis code for Carpal tunnel syndrome, 354.0.  However, in ICD 10 we have specific code for right, left, bilateral or unspecified side of limb. So, if only carpal tunnel syndrome is mention without specifying the side, we will code unspecified G56.00 as ICD 10 code for carpal tunnel syndrome.

ICD 9 code for Carpal tunnel syndrome
354.0

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ICD 10 code for Carpal tunnel syndrome unspecified
G56.00 Carpal tunnel syndrome, unspecified upper limb

G56.01 carpal tunnel syndrome, right upper limb

G56.02 carpal tunnel syndrome, left upper limb

Pain in Forearm ICD 10 codes can also be used

M79.631, pain in right forearm

M79.632, pain in left forearm

M79.639, pain in unspecified forearm

Read also: Total hip arthroplasty coding Tips

Includes and Excludes with CPT code for Carpal Tunnel Syndrome

Repair of medial nerve or Neuroplasty includes external neurolysis and transposition. For performing internal neurolysis, operating microscope is used; use CPT code 64727 in addition with the primary procedure.

For endoscopically performed procedure for carpal tunnel release, do report CPT code 29848. Do not use CPT code 64721 for endoscopically performed carpal tunnel release.

  • 29848 – Endoscopy, wrist, surgical, with release of transverse carpal ligament

For facial nerve decompression, do use CPT code 69720.

Few similar CPT code like carpal tunnel release you can check below.

CPT code 26055 Tendon sheath incision (eg, for trigger finger release)

Finally, I hope after reading this article you will confidently code CPT code for carpal tunnel release and ICD 9 and ICD 10 for carpal tunnel syndrome. Do share this article if you find it helpful.