Can We Append Modifier 59?

Question:

Is it appropriate to report 64718, 64721, and 64719 together on the same hand-right side? We see there is an NCCI edit; should we append modifier 59? 

Answer:
Thank you for contacting KZA with your great question!

You are correct; there is an NCCI bundling edit in place. CPT code 64719 is bundled into 64721.

There is no overlap between an open carpal tunnel release (64721) and open ulnar nerve surgery (64718) at the elbow. Append modifier 51 to the lesser valued code.

There is an overlap between 64721 and 64719 (ulnar nerve decompression at Guyon’s canal). To report CPT codes 64721 and 64719 (ulnar nerve decompression at Guyon’s canal) there must be documentation present of pre-operative diagnostic studies indicating the presence of ulnar nerve pathology. This documentation must be listed in the pre-op diagnosis and the results in the Indication for Surgery paragraph. CPT code 64719 is not reportable with 64721 without the documentation of diagnostic test studies. If present, CPT codes 64721 and 64719 are both reportable. An NCCI edit exists, so modifier 59 is appended in the presence of documentation.

*This response is based on the best information available as of 12/19/24.