Wiki fixation osteochndral dissecans elbow

[scooter1]

I am hoping someone has experience with this. I have not had this before. Doctor is stating 24101. However, that is removal foreign body. He didn't remove anything. I am thinking 24498, but I just don't know. Diagnosis is Osteochondritis dissecans of the capitellum.
This is an open procedure. The report reads . . .
The capitellum was visualized. There was a large cartilaginous fragment that was detached posteriorly with a very small amount of bone beneath. A flap was raised. There was good bleeding bone beneath it. The cartilage was swollen. The wound was irrigated with sterile solution. The fragment was held into postiion and two 16mm SmartNails were placed across the fragment to the underlying capitellum. At the periphery of the lesion, additional 4-0 PDS sutures were placed to further secure the edge of the lesion. Wound was irrigated, capsule was closed with 3-0 PDS suture.

 

[nrichard]

I would query the physician.

Reason:
1. I don?t see an arthrotomy. (This just may well be missed in the dictation process. I would query not only the code, but to see if an addendum is needed).
2. While code 24101 is also for removal of loose body, it doesn?t take into consideration that there was hardware placed.
3. The rest of the description of 24498, says ?humeral shaft?.
My thought is that it?s probably 24101 with modifier 22 or 24999, unlisted procedure, humerus or elbow.
I?m looking at the coding companion and dx code 732.7 Osteochondritis dissecans supports medical necessity for 24101, but not 24498.