Ask Dr. Z

What codes can we report when all three procedures are done together? "PREOP DX: Left neurogenic thoracic outlet syndrome. SURGICAL PROCEDURES: 1) Left transaxillary first rib resection. 2) Left anterior scalene and partial middle scalene resection. 3) Decompressive neurolysis of the left brachial plexus. 4) Placement of AmnioFix amniotic membrane around the T1 nerve root. 5) Free run EMG and somatosensory evoked potential, left upper extremity monitoring." Can you bill 21615, 21700, and 64713 together? There is an NCCI edit between codes 64713 and 21615, but the physician feels more work is done than to report only one code. There is no NCCI edit with 21700 and 21615, but should these codes be billed together? What do you suggest coding on these cases? "FINDINGS: There was a thick band anterior scalene muscle, which was released. The T1 nerve root posteriorly was also compressed by the middle scalene, which was in part resected. The first rib was successfully removed with freeing of the space around the lower trunks of brachial plexus."