My patient’s fallen on the ice and smashed their elbow. Help me select the proper code.

Question:

We received an inquiry from a client where the surgeon wanted to report the repair of the elbow lateral collateral ligament (CPT 24343) along with radial head replacement surgery (CPT 24666) when used for addressing radial head fracture. Can we use this code combination?

Answer:

According to AAOS – Global Service Data GSD) – CPT 24666 (Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when performed with radial head prosthetic replacement) is the primary code to address this problem.  When reviewing the GSD, it clearly states that CPT 24343 is included with this procedure. As such, it is inappropriate to bill for second code. This gets to the issue that troubles many surgeons.  They would like to be paid for tissues that are divided during the approach used to perform the procedure.  In this particular case, the annular ligament and lateral collateral ligament complex must be incised to perform the radial head insertion, and even if it was torn by the injury (fracture), its surgical repair is still included with the CPT code 24666.

*This response is based on the best information available as of 03/01/18.