Orthopedic Coding Alert

Remember ligament repair abbreviations to simplify elbow ligament surgery coding.

If conservative therapies fail to help torn medial (S53.3---, S53.44--, M24.22--) or lateral (S53.2---, S53.43--) collateral elbow ligament injuries, your surgeon might opt to perform a ligament repair or reconstruction. Follow our tips to distinguish between procedures, and you’ll hit a coding homerun.

Terms, Diagnosis Can Signal Correct Procedure

Because surgeons don’t always use the words “reconstruction” or “repair” in their operative reports, you might have difficulty choosing between the following elbow ligament surgery codes:

• 24343 -- Repair lateral collateral ligament, elbow, with local tissue
• 24344 -- Reconstruction lateral collateral ligament, elbow, with tendon graft (includes harvesting of graft)
• 24345 -- Repair medial collateral ligament, elbow, with local tissue
• 24346 -- Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft).

Tip: Look for words such as “graft” in your surgeon’s documentation to help you distinguish between repair and reconstruction -- seeing “graft” means the surgeon performed a reconstruction instead of only repairing local tissue.

You should also look for other conditions that make repair impossible and create the need for reconstruction. Examples could include when the ligament was retracted and couldn’t be located, the ligament was diseased, or the tissue was friable so a repair most likely wouldn’t hold.

If the physician does not document a graft, he probably performed a repair -- but that is much less common, says Bill Mallon, MD, former medical director, Triangle Orthopedic Associates, Durham, N.C. Instead, Mallon says physicians usually perform reconstruction with a tendon graft.

Another clue: The patient’s diagnosis also can point you in the right direction. Surgeons can perform reconstruction on an acute tear, but normally use reconstruction for patients with chronic tears. If the surgeon documents a chronic tear (with terms such as “diseased ligament,” “retracted and not retrievable,” or “chronic and friable tissue not conducive to repair”), he probably reconstructed the ligament. Also, if the patient is a high-level baseball player, you will almost always see a reconstruction with a graft (Tommy John surgery).

Explanation: The lateral collateral complex consists of the radial collateral ligament (which goes to the radius) and the lateral ulnar collateral ligament (which goes from the humerus to the ulna). This information needs to be in the documentation to distinguish from the ulnar/medial collateral ligament that orthopedists reconstruct in the Tommy John surgery. The lateral ulnar collateral ligament is the true lateral collateral that surgeons repair or reconstruct, and goes from humerus to ulna, just like the medial collateral. That’s why the surgery sometimes is called an ulnar collateral reconstruction.

Know Abbreviations to Select Code

Physicians often document abbreviations instead of the full anatomical ligament name. If your orthopedist documents a torn “RCL” (radial collateral ligament) or “LCL,” he is referring to a torn lateral collateral ligament. Report RCL or LCL tears with 24343 (for repair) or 24344 (for reconstruction).

Likewise, physicians often refer to the medial collateral ligament as the “MCL,” and the ulnar collateral ligament as “UCL.” You might even see documentation for a “Tommy John” surgery, which is another nickname for UCL reconstruction. Therefore, you would probably assign 24346 if the surgeon documents a chronic tear to the UCL.

Don’t assume: This might not always be a chronic tear, experts caution. A tremendous medial or lateral dislocation could have caused a space or gap or really stretched out the ligament that required more than a repair. Talk to your surgeon to verify whether he went beyond a repair.

Watch out: The surgeon most often performs grafts from the palmaris longus tendon during reconstruction, or may use an allograft. Reconstruction codes include the graft harvest, so you should not charge a graft harvest code separately, and you cannot charge separately for use of the allograft.