# How would you code this?? Tenex procedure elbow



## jerseygirl20 (Mar 27, 2014)

Preoperative Diagnosis:
Left lateral epicondylitis.

Postoperative Diagnosis:
Same.

Procedure Performed:  
Tenex Fast Procedure - Ultrasound-guided percutaneous tenotomy of the ECRB/common extensor tendon at the lateral epicondyle.  

Gross Findings and Description of Procedure:

CONSENT:  Signed consent was obtained by patient.

ANESTHESIA:  Local with a 5 mL mix of plain 1% lidocaine and 0.25% Marcaine.  

DESCRIPTION OF PROCEDURE:  A sterile sleeve was placed over the ultrasound transducer. The anatomy was identified and the diseased tendon was seen at the common extensor tendon/ECRB near the insertion at the lateral epicondyle.

The area was prepped with an antimicrobial solution and draped in sterile fashion.  The area was then injected with approximately 5 mL of a local anesthetic with a 50/50 mix of 1% lidocaine and 0.25% Marcaine using a 25-gauge needle.  A skin wheal was placed and a tract was made down to the tendon. A #11 blade was then introduced to create a tract down to the tendon under direct ultrasound visualization.  The TX1 handpiece and ultrasonic cutting instrument was introduced.  Once the tip of the instrument was located in the hypoechoic lesion within the tendon, the foot pedal was depressed and the area was cut and removed using the TX1 instrument.  

CPT CODE- 24357 OR 24999 I am getting conflicting information so any help would be great.


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## HeidiLynn (Apr 27, 2016)

Did you get any where with this? Im looking into how to code these procedures as well. Thank you .


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## mkmgt001 (Oct 13, 2016)

*Coding Tenex FAST Procedure*

I just attended an AAPC meeting & this was discussed. This procedure is coded with CPT 24357 (Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); percutaneous).


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## OARIZA (Sep 7, 2017)

*Office Setting?*

Can this procedure be performed in an office setting?


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## eguerrero (Sep 28, 2017)

*Tenex elbow procedure*

mkmgt001:  in your response below you state you attended an AAPC meeting and how to code was discussed.  Do you by any chance have documentation on how they recommend this should be coded?  I have the same issue where the surgeon wants us to bill with the 24357, but the coding company that we use say no it has to be the 24999 which of course is not allowed by Medicare.     

I would like some back up to present that will guide us to be able to code with 24357...   Please help if you can.  

thank you, =)


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## mkmgt001 (Oct 3, 2017)

I looked back at my notes from this AAPC meeting & all I can tell you is that it was an orthopedic surgeon from Aurora Baycare who specifically told us to code the "Tenex FAST Procedure" with the percutaneous tenotomy code - CPT 24357.


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## debrak395 (Oct 3, 2017)

*Tenex Procedure - Elbow*

There is a coding reference to this procedure @ www.tenexhealth.com.  It states that the Tenex Health system combines ultrasound imaging with the ultrasonic Micro Tip hand tool that enables precise cutting (fragmentation) of the diseased tissue involving the fascia or tendon.  Because the Micro Tip is a surgical instrument and not a procedure, CPT code selection is based on the definitive medical procedure (Percutaneous Tenotomy and Fasciotomy) and specific anatomy involved as dictated in the medical record.  In this case elbow, so I would agree that the CPT code is 24357; not CPT 24999 - unlisted procedure elbow.


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## mkmgt001 (Oct 4, 2017)

Thanks Debra!


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## hai00001 (Jan 25, 2018)

*Tenex FAST procedure correct reporting*

CPT Assistant Sept 2009 pg 11 states to code the definitive procedure as the TOPAZ is a tool and not a procedure however updated guidelines have been published. 

Per the Coding Clinic for HCPCS 3Q 2017 page 3 the TENEX FAST is a minimally invasive procedure and not considered a true tenotomy. With the use of US, the procedure delivers energy to debride, cut, and aspirate the damaged tissue. Therefore, this procedure would be appropriately reported with CPT code 27599 for the percutaneous tenotomy and calcification removal on the right knee. 

Furthermore, CPT Assistant Aug 2017 pg 10 states if all aspects of the tenotomy (eg. completely dividing a tendon) are not described as performed by the current CPT code, unlisted code 27599 would be appropriate. 

It appears the TENEX reimbursement guide is dated from 2016 which is prior to the above coding references. 

https://www.tenexhealth.com/wp-cont...C.-Tenex-Health-Physician-Code-References.pdf


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## angelinezhu (Apr 6, 2018)

hai00001 said:


> CPT Assistant Sept 2009 pg 11 states to code the definitive procedure as the TOPAZ is a tool and not a procedure however updated guidelines have been published.
> 
> Per the Coding Clinic for HCPCS 3Q 2017 page 3 the TENEX FAST is a minimally invasive procedure and not considered a true tenotomy. With the use of US, the procedure delivers energy to debride, cut, and aspirate the damaged tissue. Therefore, this procedure would be appropriately reported with CPT code 27599 for the percutaneous tenotomy and calcification removal on the right knee.
> 
> ...




How about the Percutaneous Needle Tenotomy for the shoulder? Is there a code or just unlisted 23929? Thanks!


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