Wiki PLEASE HELP - Musculature slide


New Orleans, LA
Best answers
Is any one familiar with a musculature slide procedure? My physician performed this along with many others and is now being denied.

This is what she outlined in the op report as being the musculature slide:

Tenotomy scissors were used to dissect down to the extensor musculature. the interval between the ECRL and EDC tendon were sharply incised, and the ECRB was exposed. There was a Nirschl lesion in the proximal attachment of the ECRB which was excised and sent for permanent pathological specimen and measured approximately 1x1 cm. The wound was then irrigated.

The coder before me coded this as a lengthening procedure with code 24305-RT. How ever that is being denied due to not supporting the procedure performed. Any insight on how to code this would be greatly appreciated.
Upfront - I don't have an definite answer, but find this interesting as I code upper extremity only and have never heard of it.
When I research Nirschl, I find it to be an eponym for a "procedure" (Nirschl procedure[nur′shəl] a surgical procedure for treating chronic inflammation of the elbow. It involves excision of a segment from the hypercapsular tendon of the extensor carpi radialis brevis and removal of the head of the anterolateral condyle.
Mosby's Medical Dictionary, 9th edition. © 2009, Elsevier.
With this in mind have you looked at 24358, 24359.
Hopefully, others with experience with this will chime in! Thanks for presenting this case.
I have never coded a Nirschl procedure before either, that was new to me. Had bone been removed, I would have gone with the Nirschl procedure. Seems that just soft tissue was removed, so I would look at 24076.
The procedure described here is for the treatment of "Tennis Elbow," also called "Lateral Epicondylitis." The "Nirschl Lesion" is an inflammatory response to the stretching/attenuation/tearing (whatever) of the origin of the ECRB from the Lateral Epicondylar bone. If the "Nirschl Lesion" is identifiable at the time of surgery, it can be excised/debrided/removed. This is a Tenotomy procedure (2435 _), not a "Muscle Slide" procedure. Some surgeons may call this a "Nirschl Procedure," particularly if the lesion is identifiable and removable. 24358 applies to the debridement of the soft tissue lesion, with or without removal of some of the bone of the Lateral Epicondyle, but without repairing the origin of the ECRB back to the bone. 24359 is the same, but with repair of the ECRB origin back to the bone of the Lateral Epicondyle. It does not appear that your surgeon did this repair, therefore 24358 would be the correct code.

Hopefully this gives you some understanding of this disorder and procedure.

Respectfully submitted, Alan Pechacek, M.D.
Thank you everyone who replied and gave your input. I have seen this procedure atleast 5 times and had yet to figure it out. So I definitely appreciate all of your responses.