I am struggling with what should be very simple. I am looking for any advice on how to code the following. When is it appropriate to bill 26145 & 64721 together and when it isn’t.

Here is a brief example – Ctr is standard
Here is the part of the surgery I need your opinions on:
the flexor tendons had a thickened hypertrophic tenosynovium- tenolysis x 4 with pickups and temotomies. hemostasis and clsure performed.
**dx M65.4, m19.041 & G56.01 – all done in the same incision

I have one coder saying 64721 + 26145 x4 and another just 64721 and one saying add a 22 to 64721 in certain cases

Is there anything cut and dry with this
My physician says 64721 + 26145 x4 do you all agree? if not, why?
Thank you SO much for any advice