I have a physician who is adamant that a pectoralis major tendon repair would be coded using 23412 (Repair of ruptured musculocutaneous cuff open; chronic) as opposed to 24341 (Repair, tendon or muscle, upper arm or elbow, each tendon or muscle, primary or secondary) because it is a tendon repair (does not have to be just a rotator cuff tendon repair). Based on the CPT lay description for 24341 (The physician repairs one of the muscles or tendons in the upper arm or elbow, not including those of the rotator cuff), seems to align with the procedure performed.
A modified deltopectoral incision was made in the axillary fold. Dissection is carried down to the cephalic vein and the deltopectoral interval. The clavicular head was intact. Dissecting inferiorly and medially the sternal head was then identified. There was of synovial pocket with synovial fluid which was removed. The synovial tissue was then removed sharply off the pectoralis major tendon. An Allis clamp was then used to help mobilize the tendon and the tedious post posteriorly and anteriorly were released both bluntly with a finger as well as with the cautery. Once I had mobilized the sternal head of the pectoralis major tendon, the insertion site on the humeral shaft was prepared. Just lateral to the long head of the biceps I used osteotome to roughen up the cortex. Three drill holes were then placed and a slightly staggered manner. Using the Arthrex pectoralis major and the button kit. Three fiber tapes were placed through the pectoralis major tendon from superior to inferior using a locking Krackow stitch. I then placed 1 suture limb through the Endobutton and then placed the Endobutton into the humeral shaft and made sure that the Endobutton had fully deployed within the humeral shaft. This step was repeated 2 more times using the remaining 2 sutures. I then proceeded to tension the sutures to bring the pectoralis major tendon back to its donor site just lateral to the long head of the biceps. Once I had fully tension the sutures these were then tied starting from inferior and progressing superiorly. The fiber loops were then cut using a 15 blade.
I'd like to know what procedure codes other coders use for a pectoralis major tendon repair for this scenario? Any references is greatly appreciated!
A modified deltopectoral incision was made in the axillary fold. Dissection is carried down to the cephalic vein and the deltopectoral interval. The clavicular head was intact. Dissecting inferiorly and medially the sternal head was then identified. There was of synovial pocket with synovial fluid which was removed. The synovial tissue was then removed sharply off the pectoralis major tendon. An Allis clamp was then used to help mobilize the tendon and the tedious post posteriorly and anteriorly were released both bluntly with a finger as well as with the cautery. Once I had mobilized the sternal head of the pectoralis major tendon, the insertion site on the humeral shaft was prepared. Just lateral to the long head of the biceps I used osteotome to roughen up the cortex. Three drill holes were then placed and a slightly staggered manner. Using the Arthrex pectoralis major and the button kit. Three fiber tapes were placed through the pectoralis major tendon from superior to inferior using a locking Krackow stitch. I then placed 1 suture limb through the Endobutton and then placed the Endobutton into the humeral shaft and made sure that the Endobutton had fully deployed within the humeral shaft. This step was repeated 2 more times using the remaining 2 sutures. I then proceeded to tension the sutures to bring the pectoralis major tendon back to its donor site just lateral to the long head of the biceps. Once I had fully tension the sutures these were then tied starting from inferior and progressing superiorly. The fiber loops were then cut using a 15 blade.
I'd like to know what procedure codes other coders use for a pectoralis major tendon repair for this scenario? Any references is greatly appreciated!