# Elbow ligament and tendon repair



## ReignRuby (Feb 26, 2020)

Advice please.  

I have coded the below as CPT 24343.  I am on the fence as to adding code 24359-59.  This is a workcomp case.  This was done under one incision, however the tendon was repaired.  Thoughts?


PROCEDURES PERFORMED:
1. Right elbow radial collateral ligament repair, (CPT code 24343).
2. Common extensor tendon repair, (CPT code 24359).

 A longitudinal incision was made centered over the lateral aspect of the right elbow.  Blunt dissection was carried down to fascia.  The fascia was split in line with the skin incision.  At this juncture, we were able to visualize the full-thickness defect involving both the common extensor tendon and the radial collateral ligament with minimal retraction from their insertion on the lateral aspect of the distal humerus.  Degenerative tissue was carefully debrided with a 15-blade.  The lateral epicondyle was exposed.  The bony surface was freshened with the rasp.  We then inserted a Biomet 2.9-mm JuggerKnot suture anchor in the lateral epicondyle.  This was inserted with excellent fixation.  This was a double-loaded suture anchor.  The first pair sutures were placed through the radial collateral ligament in mattress fashion.  A second set of sutures were placed through the common extensor tendon in mattress fashion.  We first tied down the sutures to the common extensor tendon and this reduced nicely to the insertion on the distal humerus.  I then placed a slight valgus moment on the elbow and tied down the radial collateral ligament sutures, which approximated next to lateral distal humerus.  We then utilized a 2-0 Vicryl running suture secondary reinforcement for a repair.  The wound was thoroughly irrigated, interrupted 2-0 Vicryl for subcutaneous sutures were placed followed by a running 3-0 Monocryl subcuticular stitch in the skin.  Steri-Strips were placed.  A well-padded bandage was applied.


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## shecodes (Feb 27, 2020)

In my opinion, 24359 is not supported as the documentation you've provided does not show that a tenotomy was performed. 

I'd suggest looking at 24341. The usage of modifier 59 to unbundle the services would be dependent on the work comp carriers policies where you are located.


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