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Official Description

Neuroplasty and/or transposition; ulnar nerve at wrist

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

Neuroplasty and/or transposition of the ulnar nerve at the wrist is a surgical procedure aimed at alleviating nerve entrapment and compression. The ulnar nerve, which is a critical nerve in the arm, travels from the collarbone down the inner side of the arm, passing through the cubital tunnel at the elbow and continuing through Guyon's canal at the wrist before reaching the hand. This procedure is particularly relevant for patients experiencing symptoms related to ulnar nerve compression, such as pain, numbness, or weakness in the hand and fingers. The surgical intervention involves making a zigzag incision at the base of the palm on the little finger side, extending over the wrist, to access the ulnar nerve. The surgeon then incises the roof of Guyon's canal and meticulously divides any scar tissue, adhesions, or other structures that may be compressing the nerve. The goal is to free the ulnar nerve from any surrounding tissue that may be causing entrapment, thereby restoring normal function and alleviating symptoms. Following the procedure, the soft tissues are closed in layers to promote healing and recovery.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure of neuroplasty and/or transposition of the ulnar nerve at the wrist is indicated for the following conditions:

  • Nerve Entrapment - This condition occurs when the ulnar nerve is compressed, leading to symptoms such as pain, tingling, or numbness in the hand and fingers.
  • Ulnar Nerve Compression - Compression of the ulnar nerve can result from various factors, including anatomical variations, trauma, or repetitive stress, necessitating surgical intervention to relieve symptoms.
  • Symptoms of Cubital Tunnel Syndrome - Patients exhibiting symptoms associated with cubital tunnel syndrome, such as weakness in grip strength or difficulty with finger coordination, may require this procedure for relief.
  • Symptoms of Guyon's Canal Syndrome - This syndrome is characterized by similar symptoms as cubital tunnel syndrome but occurs at the wrist level, indicating the need for surgical decompression.

2. Procedure

The procedure for neuroplasty and/or transposition of the ulnar nerve at the wrist involves several critical steps:

  • Step 1: Incision - A zigzag incision is made at the base of the palm on the little finger side, extending over the wrist. This incision provides access to the ulnar nerve and surrounding structures.
  • Step 2: Incision of Guyon's Canal - The roof of Guyon's canal is incised to expose the ulnar nerve. This step is crucial for accessing the nerve and identifying any structures that may be compressing it.
  • Step 3: Division of Impinging Structures - Any scar tissue, adhesions, or other impinging structures that may be contributing to the compression of the ulnar nerve are carefully divided. This meticulous dissection is essential to free the nerve from surrounding tissues.
  • Step 4: Nerve Decompression - Once the ulnar nerve is completely freed from any compressive elements, the surgeon ensures that the nerve is adequately decompressed to restore normal function.
  • Step 5: Closure of Soft Tissues - After the nerve has been decompressed, the overlying soft tissues are closed in layers. This layered closure promotes optimal healing and minimizes complications.

3. Post-Procedure

Post-procedure care for patients undergoing neuroplasty and/or transposition of the ulnar nerve at the wrist typically includes monitoring for any signs of complications, such as infection or excessive swelling. Patients may be advised to keep the surgical site clean and dry, and to follow specific instructions regarding activity restrictions to promote healing. Physical therapy may be recommended to aid in recovery and restore function. The expected recovery time can vary, but patients are generally encouraged to gradually resume normal activities as tolerated, while being mindful of any lingering symptoms that may require further evaluation.

Short Descr REVISE ULNAR NERVE AT WRIST
Medium Descr NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST
Long Descr Neuroplasty and/or transposition; ulnar nerve at wrist
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P5E - Ambulatory procedures - other
MUE 1
CCS Clinical Classification 6 - Decompression peripheral nerve

This is a primary code that can be used with these additional add-on codes.

0882T New Code for 2024 Add on code MPFS Status: Carrier Priced APC N ASC N1 Intraoperative therapeutic electrical stimulation of peripheral nerve to promote nerve regeneration, including lead placement and removal, upper extremity, minimum of 10 minutes; initial nerve (List separately in addition to code for primary procedure)
64727 Addon Code MPFS Status: Active Code APC N ASC N1 PUB 100 CPT Assistant Article Internal neurolysis, requiring use of operating microscope (List separately in addition to code for neuroplasty) (Neuroplasty includes external neurolysis)
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
SG Ambulatory surgical center (asc) facility service
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
CR Catastrophe/disaster related
CS Cost-sharing waived for specified covid-19 testing-related services that result in and order for or administration of a covid-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the covid-19 public health emergency
F5 Right hand, thumb
GC This service has been performed in part by a resident under the direction of a teaching physician
GW Service not related to the hospice patient's terminal condition
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
U1 Medicaid level of care 1, as defined by each state
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
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