Orthopedic Coding Alert

Baseball season has arrived, which means orthopedists should expect to see a sudden increase in elbow ligament injuries. You can stay out of left field by assigning a ligament reconstruction code (24344, 24346) if the orthopedist performs a graft, and a repair code (24343, 24345) if the patient suffered an acute tear requiring no graft. Baseball fans are all too familiar with torn medial (841.1) and lateral (841.0) collateral ligament injuries, which have sidelined such famous major-league pitchers as John Franco and John Smoltz. But these injuries can affect amateur players and even those "weekend warriors" who don't warm up appropriately before picking up the baseball or basketball. If conservative therapies fail, orthopedists usually perform either a ligament repair or reconstruction, depending on the breadth of the injury, and each surgery poses its own coding challenges. Grafts Signal Reconstruction Because orthopedists don't always use the words "reconstruction" or "repair" in their operative reports, coders may have difficulty choosing from 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). "The main key word to look for when distinguishing between repair and reconstruction is 'graft,'" says Nancy L. Williams, CMA, CPC, coding specialist at the Center for Sports Medicine and Orthopaedics in Chattanooga, Tenn. "If the orthopedist documents a graft, then you know he has performed a reconstruction rather than just repairing the local tissue." If the physician does not document a graft, he or she probably performed a repair. In addition, the patient's diagnosis can provide essential clues. "While orthopedists could perform a reconstruction on an acute tear, they most often use reconstruction on patients with chronic tears," Williams says. If the orthopedist documents a chronic tear, therefore, he or she probably reconstructed the ligament.

To distinguish between lateral (24344) and medial (24346) collateral ligament reconstruction, you should note that the lateral collateral ligament attaches the humerus to the radius, while the medial collateral ligament attaches the humerus to the ulna.

Orthopedists often document abbreviations instead of the full anatomical ligament name. If the orthopedist documents a torn "RCL," "radial collateral ligament" or "LCL," he or she is referring to a torn lateral collateral ligament.

Likewise, physicians often refer to the medial collateral ligament as the "MCL," "ulnar collateral ligament" or "UCL." Therefore, you would probably assign 24346 if the surgeon documents a chronic tear to the UCL, or if he or she documents a [...]