Wiki Need Help with CPT Codes!!! I am coding 24346,24344,24366,24685, CPT codes 64718 and 24345 bundle

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msbrandy4827@gmail.com

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Please see attached surgery in question. Need assistance due to CPT code 24666 vs. 24366, and coding CPT code 24341 vs. 24344 and 24346. A few of my coworkers have reviewed the note, but we are not agreeing on all codes. So I am posting here to get some other opinions. There is so much going on in the surgery note and it gets a little confusing. Thanks in advance.
 

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Do you feel the procedures performed list matches up to what is actually described in the op note? It helps to outline each place in the op note where the code you are choosing is located. Were NCCI edits checked, does the payer follow NCCI? Were the CPT guidelines checked to see if there are any specific includes/excludes/code also or code/first notes? Do you have access to ortho resources such as the AAOS global service data books, codex, or other resources such as CPT Assistant and if so, have they been checked?
It is helpful when posting full op notes in one run-on sentence in the forums to give rationale for your coding choices and what, specifically you are looking for help with. Listing the codes you would choose in order with modifiers and why is great.
 
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Unfortunately, I did have the paragraphs separated, but you can only post so many words in the question section. I do have access to AAOS and everything else. I will take everything you stated into consideration the next time I post in the forum. Thank you.
 
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Oh wow character limit! That stinks.
We want to see what your thinking is and the code choices/substantiating sources before we just code the case. That's why many of us that help on the forums ask what your thoughts are instead of just coding it. To help with learning, not just giving out codes.
 
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What were the diagnoses listed on the case? And, the mechanism of injury? Does the word Monteggia appear anywhere?
The list of codes in the subject line has other issues. There is a medical collateral reconstruction code listed as well as a repair for the same ligament. 64718 also bundles with more than one of the CPT. There is an LCL ligament reconstruction code listed with a tendon graft. I am not seeing a graft in the report.
 
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Sorry for the delay in answering. These are the diagnosis codes I am coding: S56.512A, S5.442A, S53.092A, S56.212A, M24.832, M25.332, and M94.222. I am coding 24346-for reconstruction of the medial collateral ligament, 24344 for reconstruction of the lateral collateral ligament. 24366 for arthroplasty of the radial head with implant. Lastly, 24685-for repair of the coronoid process. Yes CPT code bundles into quite a few of these codes so that is not the issue. The issue is that one of my coworkers coded 24341 x 2 units and 24666 and this is where the confusion starts and I am needing to know if others are agreeing with her coding and not mine. I have had 2 other coworkers check the surgery and they are coding what I am coding. And of course the doctor is coding everything. Her codes are 24615, 24685,24346, 24341,24366, 24344, and 64718. I hope this all makes sense. I know what I want to say, but sometimes have a hard time explaining it. Please let me know your thoughts. Thank you.
 
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Sorry, I should have said, what are the words the surgeon used as the diagnoses in the header, not necessarily the ICD-10 codes a coder chose. What did the header specifically state at the top of the op note?
Also, would help to see what the implants list says on the case. The reason I am asking this is because it could make a difference in the CPT coding. Because some of the descriptions ("worn away and missing", "covered with scar tissue" "remaining partial fracture" in the body of the note you posted makes me wonder if this is a recurrent dislocation or old injury problem versus a new, acute fracture. It also appears like it could be a chronic problem with a new, acute injury (fall on elbow, etc.) on top of it. It's hard to tell with only parts of the whole note. If you can redact the note and post the whole thing at once, I can help you better. In the ICD-10 list you posted as what is coded, some of those are chronic wrist dx which don't align with the posted note. This is a pretty big elbow case so not having the whole note makes it difficult to help. The way I see it is, there are issues with all three lists of CPT codes you gave as what folks chose.

This is the section about the radial head arthroplasty, which appears to be 24666. Why? It says it's for treatment of a fracture. I understand why you chose 24366 but that is more for chronic (arthritis, recurrent dislocation) problems where 24666 is for acute/fracture. However, knowing the other things I asked above *may* change that coding "The superior one-third of the radial head was actually worn away and missing. There were some free fragments that were floating, but this was quite flattened and covered with scar tissue, and there was also remaining partial fracture as well of the remaining head. There was actually no remaining significant fragments to be able to secure to this one-third of the radial head for an ORIF, but this presented significant instability with flexion as the head would slip out and go under the capitellum. Therefore, it was elected to perform a radial head arthroplasty. It was carefully cut at the neck, prepared for a size-8 stem, and then matched to a 22 radial head. The trials were placed and the final was placed. There was a small nondisplaced crack of the radial neck and a 20-gauge wire was carefully placed around this and then secured, and then the radial head was checked and had no looseness or instability. This reduced well and was checked under C-arm guidance with good distance at the PRUJ and the radiocapitellar joint alignment. "

It's kind of like the difference between 27236 in the hip for a hemi for fracture versus 27125 for more chronic problems like osteonecrosis, OA, etc. These are commonly miscoded CPTs for both the hip and elbow.
 
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msbrandy4827@gmail.com said:
Hi. I am attaching the surgery so you can get exactly what you are asking, and hopefully help. Thank you again.
Click to expand...
I agree with your co-worker on the 24666 and 24341x2. I agree with the provider on 24615, 24685, 24341, and 64718 (if they feel strongly to report, see below). Good Luck!

Here 's how I coded it. See last paragraph of op note for a 22 modifier. Not sure you'd want to slap a 22 on every line, it needs to be a little more specific on which parts were the ones that required it. My view - I would put it on the 24615 only.
1. 24341x2 (extensor and flexor tendon repair)
2. 24666 (radial head arthroplasty for fracture)
3. 24615 (open treatment of acute or chronic elbow dislocation)
4. 24685 (ORIF coronoid fx)
5. 64718 (cubital tunnel) *This is the questionable one. This CPT bundles with all four of the other CPT per NCCI. However, according to AAOS GSD, it bundles with 24341 only when done for exposure. In this case it was done to treat the nerve tightness and contusion (per op note). AAOS GSD is silent on 64718 with either 24666 or 24685. AAOS GSD shows 64718 is not included in 24615. So, provider would have to decide if they want to unbundle it. You would also want to consider the payer. You would have a diagnosis to support the 64718 in my view. If you ask multiple coders you would get different answers, as you have seen. :)

Notes - Why not report the ligament codes? 24615 includes the ligament work (e.g.; 24345, 24343, etc.)
There is an AHA Coding Clinic regarding whether to report a repair or reconstruction CPT when the internal brace is used. I don't have access to this resource right now so I can't see what it says. In my view, the CPT would be 24343 in this case because there was no tendon graft. The note specifically states they chose not to place a tendon. However, I can't confirm with AHA. Either way, it wouldn't matter because both of those (24343, 24344) bundle with the 24615 anyway. If you have access you may want to confirm just for further research/info. https://www.findacode.com/newslette...al-ligament-repair-internalbrace-H204011.html

The reason it is 24666 is because it was for fracture not a chronic OA type or other chronic injury. There could be a debate about it due to what is stated in the first paragraph of the findings section which stated, "...radial head and quite flattened and more chronic appearing along with the fracture..." But, because the injury is listed as a fall about a month prior, I would probably go with the 24666.
Reminder - double check you ICD-10s. Some don't align with the elbow as listed above.
 
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Thank you so much for your help. You have definitely helped me understand this note and the coding for it. Thank you for the information regarding 24666 vs. 24366 this will definitely help with future coding of the elbow. I will check my ICD-10 codes as well.
 
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