# Help with Medial epicondylectomy



## smcbroom (Jun 16, 2008)

I do not have my current Coders Desk Reference to check on this but I know since the 2007 codes 24350-24356 have changed codes to 24357-24359, I'm not sure how to code this....Right medial epicondylectomy with neurolysis of the ulnar nerve right elbow and local injection of ropivacaine right elbow.  If anyone can be of assistance, I would appreciate it.


----------



## mbort (Jun 16, 2008)

24358 would be my first guess without seeing an op note


----------



## smcbroom (Jun 16, 2008)

Maybe this might help....

A longitudinal incision was made over the medial epicondylar area.  Sharp dissection was carried through the skin and blunt dissection carried through the subcutaneous tissues.  Adequate hemostasis was obtained with electrocautery.  Any branch of the antebrachial cutaneous nerve was protected.  Initially, the nerve was found proximally and then dissected further proximally.  Army-Navy was placed up in order to retract the skin and the nerve was dissected digitally as well as long DeBakey pickups proximally through the intermuscular septum.  The nerve was then followed distally through the cubital tunnel down through Osborne's fascia.  After complete release of the nerve, sharp dissection was carried out anteriorly over the medial epicondyle.  A large posterior flap was then elevated off the medial epicondyle as well as a smaller flap anteriorly.  An osteotome was then used in order to perform medial epicondylectomy.  Rongeurs were then used in order to smooth off the medial epicondylar region in order to get a smooth bony surface.  The posterior flap was then brought up to the anterior flap with pants-over-vest horizontal mattress sutures with the knots being placed anteriorly so the Vicryl would not be anywhere near the nerve.  The nerve was again checked for gliding.

The wound was again copiously briskly irrigated.  Vicryl 2-0 was used in order to close the subcutaneous tissues.  The wound was again copiously irrigated and then a running Prolene stitch was used in order to close the skin.  Steri-Strips were applied.  Ropivacaine was injected locally.  A bulky dressing was applied.  The tourniquet was released.  She was placed into a brace and taken to recovery room in stable condition with no complication.


would it still just be 24358?

Thanks!


----------



## mbort (Jun 17, 2008)

that changes things, I would go with 24359 & 64718


----------



## smcbroom (Jun 17, 2008)

thank you!  I appreciate your input!


----------

