Wiki 24342 vs. 24340 Controversy

[kdavis012]

I am wondering if anyone has any good, solid information regarding the difference between CPT codes 24342 (reinsertion of ruptured biceps or triceps tendon, distal, with or without tendon graft) and 24340 (tenodesis of biceps tendon at the elbow (separate procedure)? The descriptions for both of these CPT codes read similarly in ASC expert and I am now finding that I am second guessing myself whenever I have used 24342 for a ruptured biceps reinsertion. I am also not finding much in the way of any good articles (i.e. Codify) to assist me in making the right code choice.

Thanks in advance for any insight into this matter!

 

[amyjph]

One thing you can look for is button, endobutton or tunnel for 24342. It sure is difficult to tell sometimes which one.
24342, in my experience, is usually a stand alone procedure and not normally done for chronic, degenerative tendon issues. Usually the 24342 patient is male, middle-aged-ish (40's), was lifting something, and the tendon popped as the mechanism of injury. They usually have the popeye deformity. Like you stated above, 24340 has separate procedure designation and is usually done as part of a more complex elbow case. The distinction of the words distal and ruptured in 24342 is also important. I think it comes down to the exact diagnosis and the rest of the op report taken together. What does the provider call it in the header? Usually that can help.

Did you look in Coding Clinic or CPT Assistant? I also find it helps to watch a surgery of each type if you can find one online to see what they do. In my experience working in a large group, I would speak with my docs about the case types when coders had questions. In this type of case, I knew they rarely to never did 24340 so that helped me too. You could do that if it's an option for you.