Orthopedic Coding Alert

Question: Two physicians worked for more than an hour but failed to repair the pectoralis major tendon. How should I report this, and does a modifier apply?

Delaware Subscriber

Answer: Your code selection hinges on the surgeons' documentation regarding their actual work and the level of difficulty. One good possibility is 24341 (Repair, tendon or muscle, upper arm or elbow, each tendon or muscle, primary or secondary [excludes rotator cuff]) because that was the original intent of surgery.

Adding a modifier such as 52 (Reduced services) might be appropriate. Consider the amount of time spent working on the patient, the work done, and the patient's risk from being under anesthesia that long. If the documentation supports modifier 52 since the procedure  was "partially reduced" (not completed), add it to the procedure code on your claim.