Orthopedic Coding Alert

Remember ligament repair abbreviations to simplify elbow ligament surgery coding.

Baseball players are gearing up for the season, which means your orthopedist could see a sudden increase in elbow ligament injuries. If conservative therapies fail to help torn medial (841.1) or lateral (841.0) collateral 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.

"Also look for other conditions that make repair impossible and create the need for reconstruction," says Kathy Nelson, CPC, COSC, an orthopedic coder with Fletcher Allen Health Care in Burlington, Vt. Examples could include when the ligament was retracted and couldn't be located, the ligament was diseased, or the tissue was friable so a repair most likely wouldn't hold.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, an orthopedic surgeon and medical director of Triangle Orthopaedic Associates in 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.

Explanation: The lateral collateral complex consists of the radial collateral ligament (which goes to the radius)  and the ulnar collateral ligament (which goes from the  humerus to the ulna). The 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: "It might not always be a chronic tear," Nelson cautions. "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. Reconstruction codes include the graft harvest, so you should not charge a graft harvest code separately.