Just curious if anyone has ever billed 24359 Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); debridement, soft tissue and/or bone, open with tendon repair or reattachment with modifier 22 for the additional work for both the Medial & Lateral? My provider incised both epicondyles of the elbow; however the code description is medial or lateral which clearly means it can only be billed once for each elbow, but because of the additional incision. Would it be inappropriate to add modifier 22?
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Wiki 24359 Lateral & Medial Tenotomy
- Thread starter LIVE2CODE
- Start date
Orthocoderpgu
True Blue
If your surgeon did not repair/reattach the tendons then you are billing the wrong code. Code 24359 requires the repair or reattachment of a tendon. The debridement of the tendon or bone is secondary and just part of the more inclusive procedure. If it's done both medially and laterally it can be billed twice per the MUE. If the tendons are not being repaired, consider 24358 instead.
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There's no issue or question about the code. The work is definitely documented. The elbow is considered a s single joint, and I have billed 24359 twice for the same elbow, different claim, but it denied for benefits maxed.
Thank you for your response
Thank you for your response
Orthocoderpgu
True Blue
Repair or reattachment is documented?
Orthocoderpgu
True Blue
If a repair or reattachment was done on the medial and lateral sides code 24359 would be billed twice. No modifier -22. To be honest, something seems a bit off about this. Would you be able to redact the op note and either post it or IM to me?
made a 5 cm oblique incision over the medial epicondyle. I dissected down onto the fascia which I opened to expose the tendon. There was a clear split interstitial tear of the flexor pronator wad on exam. I took a picture of this to confirm this. With a 15 blade, I debrided all of the frayed, denuded, degenerative tendon at the insertion on the medial epicondyle. I then excised some osteophyte formation on the medial epicondyle with a rongeur. I decorticated the insertion point to allow a bony bed for tendon healing. At its anatomic origin I then placed a Arthrex mini bio composite suture anchor. I repaired the split tendon tear to the suture anchor to repair and reattach the tendon anatomically to the medial epicondyle. I did this with a running locking FiberWire stitch attached to the suture anchor. I was happy with the tendon repair and stability. I then released the ulnar nerve at the cubital tunnel by releasing Osborne's ligament. I then released the ulnar nerve proximally through the triceps fascia all the way through the arcade of Struthers to and through the intermuscular septum. I then released the nerve through the 2 heads of the FCU and FCU aponeurosis. I then examined the nerve under full composite flexion and extension and it did not appear to sublux so there was no need for transposition. I then turned my attention to the lateral condyle. I made a 3 cm oblique incision over the lateral epicondyle. I dissected down onto the fascia which I opened to expose the tendon. The ECRB origin was heavily denuded due to chronic lateral epicondylitis. With the Beaver blade I removed all of the frayed, denuded, degenerative tendon at the insertion on the lateral epicondyle. I then excised some osteophyte formation on the lateral epicondyle with a rongeur. I decorticated the insertion point to allow a bony bed for tendon healing. At its anatomic origin I then placed a Arthrex mini bio composite suture anchor. I tied the surrounding tendon to the suture anchor to repair and reattach the tendon anatomically to the lateral epicondyle
Orthocoderpgu
True Blue
You have a re-attachment on both the medial and lateral sides. Code 24359 would be correct for each repair. So code 24359 would be billed twice, the second one with either a -59 modifier or -XS if the insurance is medicare.