Orthopedic Coding Alert

Question: What is the appropriate code to report for pectoralis major muscle repair? It is not part of the rotator cuff, so we don't know if we should report an unlisted-procedure code.

Texas Subscriber

Answer: Practices often mistakenly report 23410 (Repair of ruptured musculotendinous cuff [e.g., rotator cuff] open; acute) for pectoralis major muscle repairs because the muscle plays a vital role in shoulder function. You are correct, however, in your decision to avoid the code for rotator cuff repair, because the pectoralis is classified within CPT's "upper arm and elbow" section, not the "shoulder" section.

You should therefore report 24341 (Repair, tendon or muscle, upper arm or elbow, each tendon or muscle, primary or secondary [excludes rotator cuff]) for this type of procedure.