Wiki Triceps Defect Repair

[lcole7465]

I have a provider that performed an Arthrotomy on the elbow along with repairing a triceps defect. The provider has coded 24342, but I don't see that an actual reinsertion was performed. Op note reads: "An incision was then outlined in marker over the olecranon draining sinus, which actively drained purulent material.* The skin was incised sharply with an ellipse made around sinus. and then tenotomy scissors were used for further dissection. The deep portion of sinus tract was sent for culture. Aerobic an anaerobic cultures were taken.* The surrounding tissue was debrided with combination of curette and rongeur.* We noted a longitudinal defect within the midline of the triceps. Patient had XR imaging which hinted at previous injury but did not complain of weakness. Given the possibility that there was communication with olecranon fossa, the defect was carried down to olecranon fossa and arthrotomy was made. Once the area was adequately debrided, Betadyne and then Gentamicin-Saline mixture was used to thoroughly irrigated the area.* Any remaining necrotic tissue was debrided and more irrigation used.

The triceps defect was closed with 0 Vicryl. The subcutaneous tissue was then closed with 2-0 monocryl and skin closed with staples. Xeroform, 4x4's, webril was used to dress wound. A anterior elbow splint was applied"

I have 24101 for the arthrotomy. I'm having a problem finding a code for the repair. Should I maybe use an unlisted code?

Thanks

 

[AlanPechacek]

I tried to respond to your query yesterday, but my answer disappeared into space. So, I will try again. This appears to be an I & D, with Debridement and Irrigation, of an episode of Septic Olecranon Bursitis. But, because of your surgeon's identification of the longitudinal triceps strain (old/chronic and "unhealed"), he was concerned about the possibility that the infectious process may have extended into or involved the joint, so he did an arthrotomy through the old strain to explore, debride, and drain the joint (if necessary/involved). It doesn't appear that the joint was in fact infected. In closing the joint and wound, he also "repaired" the old triceps strain on his way out. I think your choice of 24101 for the procedure is correct, even though no joint infection was found. The remaining issue regards the repairing of the triceps strain is coding it properly with a diagnosis code (in the Postoperative Diagnosis List) and a repair code. The documentation in the Op Note does indicate a history of an injury to the region in the past, imaging evidence of the lesion, even though there was no apparent functional deficit from it. Since there are no codes in ICD-10 for "old or chronic tendon strains," healed or unhealed, you would have to go with an acute injury code with an appropriate 7th Character. I would go with S46.31 _ S: Strain of the Triceps (tendon), and choosing S because the fact that it was "unhealed" would make it a Sequelae. It is an unusual "strain" in that it is longitudinal, whereas most tendon strains are transverse, but a strain is a strain either way. As for its repair, there is 24341: Repair of tendon (or muscle) of elbow (or upper arm), (primary or) secondary, each muscle or tendon. This code excludes Rotator Cuff Repair. You would have to probably add Modifier 22 for Increased Procedural Service. If the documentation provides sufficient support for doing this procedure in addition to the Arthrotomy, then you may get away with submitting it. It appears to, but it is "iffy." You should probably send the documentation up front rather than waiting for it to be requested later.

This is an interesting and challenging case. I have provided my best analysis and recommendations. I would be interested in what others have to say. I note that there have been no prior responses.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com