# Latissimus Dorsi Tendon transfer at shoulder



## bluebird301@gmail.com (Mar 13, 2017)

Hi All,    I am coding the below :  The procedure was done in conjunction with Reverse TSA.     This does not, to me, sound like CPT  24301 and I am curious what your thoughts are?  

"The right shoulder and arm was then prepped and draped in the usual sterile fashion. An anterior deltopectoral
approach was used. The incision was carried down through the subcutaneous tissue. Cephalic vein was
identified and retracted laterally with Browne retractor in the deltoid. Pectoralis major muscle and tendon were
identified. It was released from the humerus in the upper 2 cm. The Alexis soft tissue protector was then placed
under the pectoralis major muscle and tendon and deltoid. Browne retractor was then placed again under the
deltoid. The clavipectoral fascia was released. The conjoined tendon was then retracted medially. The latissimus
dorsi tendon was then harvested. The pectoralis major tendon was taken further down off of the humerus to
fully expose the latissimus dorsi tendon. This was a nice thick latissimus dorsi tendon that was well attached. It
was released off the insertion site of the humerus using #15 blade while protecting the neurovascular structures
in the axilla. The tendon was then secured with two #2 Force Fiber sutures along each side of the tendon using a
locking Krakow fixation stitch to secure the tendon fixation for about 2 cm on either side of the tendon. The
tendon was then mobilized along the myotendinous junction down to the neurovascular structures. The tendon
had good mobility. A large curved clamp was then placed around the humeral neck keeping the clamp on bone in order to avoid the neurovascular structures. 
This was then used to pass a suture to transfer the tendon to the external surface of the greater tuberosity."


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## AlanPechacek (Mar 13, 2017)

The procedure as described in your query leaves out some pertinent information that may be in his report elsewhere, such as the preoperative diagnoses and the surgical/clinical indications for the procedure.  What you do describe is one of the procedures to "reconstruct" a chronic badly torn, retracted, unrepairable rotator cuff.  It is not done often in the grand scheme of things, but it is one way of recreating a rotator cuff where none exists.  (Your surgeon does not describe in detail the status of the patient's rotator cuff.)  If this is what he was doing with the Latissimus Dorsi Tendon Transfer, then the correct code would be 23420: "Reconstruction" of a complete chronic rotator cuff tear.  This would be in addition to the Arthroplasty as I don't think this would be an "integral" part of that procedure.  This could be added with a Modifier, probably 51 for Multiple Procedure, &/or 22 for Increased Procedural Services.  (Submit the Operative Report as supportive documentation.)

The code you mention, 24301, would apply to a muscle or tendon transfer in the upper arm (humeral region) or elbow, but not the shoulder.

I hope this helps.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com


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## bluebird301@gmail.com (Mar 14, 2017)

Thank you very much Dr.  Pechacek.  Your information is exceedingly  helpful.  Our surgeon has done two of these procedures,  Reverse TSA with the lat dorsi tendon transfer, and it was for nonfunctioning rotator cuff pathology/chronic tear.  I will definitely offer this information to all of the coders in our practice/facility.   Thank you again


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## AlanPechacek (Mar 14, 2017)

bluebird301@gmail.com said:


> Thank you very much Dr.  Pechacek.  Your information is exceedingly  helpful.  Our surgeon has done two of these procedures,  Reverse TSA with the lat dorsi tendon transfer, and it was for nonfunctioning rotator cuff pathology/chronic tear.  I will definitely offer this information to all of the coders in our practice/facility.   Thank you again



You are welcome.  Happy to help.  Also, check the Preoperative Diagnosis used.  Is he using "Primary" Osteoarthritis of the Shoulder (M19.01 _) or "Rotator Cuff Arthropathy," which does not have an ICD-10 code of its own, but which is actually a "Secondary" Osteoarthritis of the Shoulder (M19.2 _)?  It is "Secondary" by virtue of the fact that the Osteoarthritis develops as a consequence of a chronic, retracted, unrepairable rotator cuff tear of sufficient duration that the Humeral Head has "migrated" (subluxed) upward (superiorly) so that it rubs (articulates) with the Acromion above.  This is the type of shoulder arthritis for which the Reverse Shoulder Arthroplasty was originally developed so as to get the Humeral Head and the Glenoid back in their "normal" relationship (alignment).  Reconstructing the Rotator Cuff by use of the Latissimus Dorsi transfer (as was done in your case) would help maintain that relationship/stability of the prosthetic joint, and hopefully improve the chances for long term success of the procedure.  For the combination of Reverse Shoulder Arthroplasty with/and Rotator Cuff Reconstruction, as was done in your case, the M19.2 _would be a more "specific" code.  You may want to "run this by" your surgeon for his input too.

Alan Pechacek, M.D.


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