Wiki Arthrotomy (olecranon) and excision of olecranon bursa


Canton, NC
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I am struggling with the fact that the codes bundle for these procedures and what seems to be the lesser procedure (24105) is the primary code and the arthrotomy is code 2 of the pair (24101/24000).
PROCEDURE: Incision and drainage of chronic draining olecranon bursa from left elbow (Charcot joint) with arthrotomy of pseudojoint, Charcot joint, left elbow and excision of chronically inflamed/infected olecranon bursa, left elbow.
Physician incises and identifies chronically inflamed bursa, opens bursa, collects fluid, sends for culture, etc., physician then carefully dissects the bursa down to origin of pseudojoint and opens joint capsule. Pseudojoint is thoroughly irrigated with 3L normal saline using cystoscopy tubing including removal of several large foreign bodies. At end of procedure surgeon excised majority of the olecranon bursa and sent for pathologic exam. A small bit was left attached to the pseudojoint capsule. Closure ensued.....
Any guidance in the proper coding of this is very much appreciated! Thanks in advance.... (Wondering, would the fact that he did not excise the entire bursa be enough to allow the use of the arthrotomy code only?....thoughts?)
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I agree with your dilemma. The "weighting" and "bundling" of these procedures is backward. The surgery on the joint, of which the code 24101 seems to be the more aligned with what he did, should be weighted more than a bursectomy (24005), which is a lesser procedure by far. There are some unusual aspects of your case in that I "suspect" that the patient had a chronically infected and draining elbow joint (Septic Arthritis of a Charcot Elbow Joint). The Op Report as described "sort of/maybe" supports this. The infection went from the joint through the capsule into the olecranon bursa and finally out through the skin. "Normally" an Olecranon Bursitis does not communicate with the joint. Unfortunately I cannot find a good way around this either. You may have to look at 24102, see how that is weighted compared with the others, and go with it since it includes "synovectomy'" which would seem to include the partial excision of/for the inflamed bursa.

Good luck with this.

Respectfully submitted, Alan Pechacek, M.D.