64719 & 69990+

CAN SOMEONE HELP ME WITH THIS. MY DOCTOR WANTS TO BILL THESE TWO CODES TOGETHER
BUT CCI INDICATES THEY CAN NEVER BE BILLED TOGETHER UNDER ANY CIRMCUMSTANCES.


What could be used to describe this instead?
General anesthesia was completed.
Perioperatively, the patient received IV antibiotic therapy. A tourniquet was
placed on the right arm with padding. Right upper extremity was then scrubbed
with Chlorhexidine, wiped with alcohol, and prepped with DuraPrep. It was
then draped in sterile fashion. This procedure was carried out under 2.5 time
loupe magnification initially followed by the Zeiss operating microscope. The
upper extremity was scrubbed with Chlorhexidine, wiped with alcohol, prepped
with DuraPrep. It was then draped in sterile fashion. A formal time-out was
performed. The upper extremity was then exsanguinated and tourniquet inflated
to 250 mmHg. The previous scar over the distal forearm was excised
elliptically with a 1 mm border of scar remaining. It was extended proximally
for 6-7 mm in a longitudinal fashion and zigzagged across the wrist in line
with the ulnar tunnel distally going obliquely across the wrist crease. The
dissection was carried down through the subcu plane with note of dense
scarring present. The ulnar artery and nerve bundle were identified
proximally. Takedown of the scar at the level of the ulnar tunnel was
performed sharply with note of thickening around the fibers from the FCU which
were felt to be creating a scar bridge which may be compressing the ulnar
nerve. The nerve was freed circumferentially with care to preserve the ulnar
artery. Following excision of the scar and tracing the nerve
circumferentially freeing adhesions from the level of the distal forearm
through the scarred area and across into the proximal palm, the nerve was then
isolated fully using vessel loops. The Zeiss operating microscope was then
introduced with note of previous injury to the nerve visible. There was no
neuroma in continuity, no even epineurial scarring present. Fascicles could
be identified easily. Subsequently, a 5 mm neurogen conduit was split and
wrapped around the nerve for protection, the end sutured to itself, and a
tacking sutured to the epineurium performed under the Zeiss operating
microscope with 8-0 sharp point nylon suture. There was no tension on the
nerve. It showed easy gliding capabilities with wrist flexion/extension.
Subsequently, the area was blocked with 0.25% Marcaine and closed in simple
fashion with 4-0 Novafil and a dressing of Xeroform, 4 x 4's, Kling cast
padding, and an ulnar gutter splint supporting the wrist as 0 degrees of
extension with digits free. Tourniquet deflation revealed good blood flow to
the patient's right hand. I was present for all aspects of this procedure