Wiki CPT Code for left trapezius muscle repair

[koppiej@erudite-solutions.com]

Any help would be appreciated. This is normally a spine surgery, neurovascular surgery practice. First time I have encountered something like this. Trapezius is top of back and neck (diamond shaped superficial muscle). Repair would be a revision I suppose. Unlisted procedure won't get paid by insurance. As John Lennon sang, HELP!! (please)

Thanks,
Junior

 

[amyjph]

Good question. For pectoralis we use 24341. Where is it being repaired in your case? I would venture to use 24341 if it's repaired at the clavicle or acromial area. If not, I think you're going to be forced to use unlisted. Did you check CPT Assistant? Why wouldn't an unlisted be paid? You can use an unlisted, compare to a code for RVU purposes, submit your operative report and explain there is no applicable CPT code for the procedure performed. It will take longer and probably require more work to collect. Was it done alone or as part of other procedures? Was it repaired due to being torn or was it cut through to perform something else?

It was definitely a repair and not a transfer?

 

[koppiej@erudite-solutions.com]

Thank you for your reply. This is for a surgical schedule. The actual surgery has not yet been performed. It is to get insurance authorization. I have queried the physician for further details. I understand that using an unlisted code would require clarification and explanation. I asked our lead coder and she indicated an unlisted code has never been used to her recollection (at this practice).

I did find additional patient notes and the physician indicates "Options of surgical repair of the ligament and bring it back towards midline versus treating this with physical therapy and stabilization of the shoulder girdle were reviewed at length".

Thank you again for the quick, informative response!

 

[amyjph]

Ah, gotcha. That would be challenging. Clinicals will probably have to be submitted and extra work on the auth side if auth is needed.