Outpatient Facility Coding Alert

Question: The orthopedic surgeon performed several procedures on a patient’s right elbow. Diagnoses included right elbow DJD (degenerative joint disease) with spurring on the coronoid and olecranon process spurs; grade 2 chondromalacia of the anterior elbow joint; synovitis of the anterior and posterior elbow joints; loose bodies in the olecranon fossa; and partial tricep tendon tear with posterior olecranon osteophyte in the triceps attachment.

The procedures he performed included:

Right elbow arthroscopic debridement, including partial synovectomy and excision of coronoid and olecranon osteophytes

Arthroscopic removal of loose bodies from the posterior elbow joint and the olecranon fossa

Open excision of olecranon spur from the tricep tendon insertion site, including repair of partial tricep tendon tear.

Can we bill for all of the procedures, or are they bundled? What are the best codes to submit?

Pennsylvania Subscriber

Answer: Yes, you can submit codes for all four procedures; they are all allowed in an ASC setting, and coding edits don’t bundle any of them together. The procedure and diagnosis coding should be as follows:

24342 (Reinsertion of ruptured biceps or triceps tendon, distal, with or without tendon graft) with modifier RT (Right side); associated diagnoses 727.69 (Nontraumatic rupture of other tendon) and V64.43 (Arthroscopic surgical procedure converted to open procedure)

24147 (Partial excision [craterization, saucerization, or diaphysectomy[ bone [e.g., osteomyelitis], olecranon process) with modifier RT and diagnoses 726.91 (Exostosis of unspecified site) and V64.43

29838 (Arthroscopy, elbow, surgical; debridement, extensive) with modifier RT and diagnoses 715.92 (Osteoarthrosis unspecified whether generalized or localized involving upper arm), 727.09 (Other synovitis and tenosynovitis), and 733.92 (Chondromalacia)

29834 (Arthroscopy, elbow, surgical; with removal of loose body or foreign body) with modifier RT and diagnosis 718.12 (Loose body in upper arm joint).