AHA Coding Clinic® for HCPCS - 2015 Quarter 3; ASK THE EDITOR
Complete neurolysis
Complete neurolysis of the nerve was carried out from the flexor carpi ulnaris (FCU) fascia, through the previous transposition zone to the triceps. The previous anastomosis site was taken down; the previous neural tube graft was resected, and a new cadaveric graft ( Avance human nerve tissue allograft) was sutured into position. CPT code 64893 , Nerve graft (includes obtaining graft), single strand, arm or leg; more than 4 cm length, did not seem appropriate as the physician did not harvest the graft. We were not sure if CPT code 64910 , Nerve repair; with synthetic conduit or vein allograft (e.g., nerve tube), each nerve, was appropriate because a synthetic conduit or vein allograft (e.g., nerve tube) was not used this time. There is also confusion as to whether the neurolysis CPT code 64718 , Neuroplasty and/or transposition; ulnar nerve at elbow, should be coded separately in this case. ...
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Article Overview
This premium article examines a nerve surgery scenario involving neurolysis, takedown of a prior repair, removal of an earlier graft, and placement of a cadaveric nerve allograft. It is aimed at coding professionals who need to understand how the case is being evaluated within CPT and how the procedure details affect coding considerations. The article focuses on the coding uncertainty created by the operative facts and the distinction between related nerve repair and grafting options.
Why This Topic Matters
Nerve surgery cases often include prior revisions, graft material changes, and multiple operative steps that can make code selection difficult. This article helps readers understand the clinical and procedural context behind those coding questions.
What You Will Learn
- How the operative narrative is structured around prior nerve surgery and revision steps
- Which CPT nerve procedure categories are being considered for the case
- Why graft source and technique details matter in nerve procedure coding review
- How this type of article frames coding uncertainty for a complex neurolysis case
Who Should Read This
- Medical coders
- Coding auditors
- Physician documentation reviewers
- Orthopedic and hand surgery billing staff
- Reimbursement specialists
Codes Discussed
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