Wiki 23395 Muscle Transfer, any type, shoulder or upper arm; single vs Biceps Tendon Muscle Transfer

midnight1995

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I have been going back and forth with the providers regarding the guidelines on 23395, as well as the Insurance are also stating that after review of the Op note the documentation does not support this Muscle Transfer and there is a better code based on the supporting documentation. There is no specific CPT for Biceps Tendon Muscle Transfer. If anyone has any incite on this it would greatly be appreciated.
Example:
The deltopectoral interval wash than incised with a #15 blade scalpel. Skin and subcuticular tissue were dissected won to the deltopectoral fascia. Skin Flaps were raised. The cephalic vein was identified and retracted laterally with the deltoid. I than incised the clavipectoral fascia. The coracoacromial ligament was preserved.
left Biceps Tendon Muscle Transfer 23395
I than traced the long head of the biceps brachii from the pectoralis major through the rotator interval and released the biceps from its origin. The biceps tendon was diseased from the groove to its insertion on the supraglenoid tubercle. I than sutured the tendon into the pectoralis major tendon as a muscle transfers.
The coracohumeral ligament was than released.
Deep retractors were placed. The rotator interval was tagged with suture. I than electrocautery to create a subscapularis peel. With increased external rotation of the shoulder, the inferior capsule was released and marginal osteophytes were excised. The should was dislocated anteriorly.
 
What else is done during the case, what is the main procedure RCR/TSA? Was the shoulder having recurrent dislocation, SLAP, etc?
Are they looking for 23440 possibly or maybe 24301.
Or, they are seeing it as a tenodesis, not a transfer. "Sutured the tendon into the pec..." They might see this as 23430.

Otherwise, the op report may not be clear enough to make a determination, and we would need to know what the whole case was and what else was done. There is more detailed info needed to describe this portion of the case.
 
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