How To Use CPT Code 24346

CPT code 24346 describes the reconstruction of the medial collateral ligament (MCL) in the elbow using a tendon graft. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 24346?

CPT 24346 is used to describe the surgical procedure in which a provider reconstructs the patient’s injured MCL in the elbow using a tendon graft. This code is used when the provider makes an incision, identifies the damage in the MCL, drills holes in the medial epicondyle and proximal humerus, harvests a tendon graft, and secures it through the tunnels created. The goal of this procedure is to restore the function of the elbow and promote healing of the MCL.

2. Official Description

The official description of CPT code 24346 is: ‘Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft).’ This code specifically refers to the surgical reconstruction of the MCL in the elbow using a tendon graft, which involves harvesting the graft as well.

3. Procedure

During the procedure for CPT 24346, the provider follows a step-by-step approach to reconstruct the patient’s MCL in the elbow:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision over the medial epicondyle, being careful to avoid the cutaneous nerve.
3. The provider identifies the damage in the MCL and splits it from the epicondyle to the sublime tubercle.
4. Using a drill, the provider creates a tunnel in the medial epicondyle.
5. Similarly, the provider drills two more holes in the proximal site of the humerus, creating a second tunnel.
6. A transverse incision is made at the wrist.
7. The provider harvests the palmaris longus tendon using a tendon stripper.
8. The harvested graft is secured through the epicondylar and humerus tunnels by suturing the free ends and also to the fascia near the intermuscular septum.
9. After restoring the position of the tendon graft, the provider closes the wound with sutures and places the hand in a splint or cast to immobilize the elbow.

4. Qualifying circumstances

CPT 24346 is performed on patients who have an injured MCL in the elbow that requires reconstruction. The procedure is typically indicated when conservative treatments, such as physical therapy or bracing, have failed to provide sufficient healing or stability. The patient must meet the specific criteria for this procedure, and the provider must determine that the reconstruction with a tendon graft is the most appropriate course of action.

5. When to use CPT code 24346

CPT code 24346 should be used when a provider performs a surgical reconstruction of the MCL in the elbow using a tendon graft. This code is specifically for cases where the graft is harvested and used to restore the function of the MCL. It is important to note that if the provider performs a repair of the MCL using local tissue, a different CPT code should be used.

6. Documentation requirements

To support a claim for CPT 24346, the provider must document the following information:

• Patient’s diagnosis and the need for MCL reconstruction
• Details of the procedure, including the incision, identification of MCL damage, drilling of tunnels, harvesting of the tendon graft, and securing of the graft
• Date of the procedure
• Any additional procedures or services performed during the same session
• Any complications or unexpected findings
• Signature of the provider

7. Billing guidelines

When billing for CPT 24346, ensure that the procedure performed meets the criteria for MCL reconstruction with a tendon graft. It is important to follow the specific documentation requirements and guidelines provided by the payer. Additionally, be aware of any bundling or unbundling issues and use appropriate modifiers if necessary.

8. Historical information

CPT 24346 was added to the Current Procedural Terminology system on January 1, 2002. There have been no updates or changes to the code since its addition.

9. Similar codes to CPT 24346

There are several similar codes to CPT 24346 that describe other procedures on the humerus and elbow. These include:

• CPT 24345: Repair of the MCL in the elbow using local tissue.
• CPT 24347: Reconstruction of the MCL in the elbow with collateral ligament augmentation device (e.g., ligament reconstruction with tendon interposition [LRTI]).
• CPT 24348: Reconstruction of the MCL in the elbow with allograft.
• CPT 24349: Reconstruction of the MCL in the elbow with autograft.
• CPT 24350: Revision of the MCL in the elbow.

9. Examples

1. A patient with a severe MCL tear in the elbow undergoes reconstruction using a tendon graft.
2. An athlete who sustained an MCL injury during a sports event requires surgical intervention to reconstruct the ligament.
3. A patient with chronic instability in the elbow due to a previous MCL injury undergoes reconstruction with a tendon graft to restore stability and function.
4. A patient involved in a motor vehicle accident sustains a complex MCL injury in the elbow and requires surgical reconstruction.
5. A professional athlete with an MCL tear in the elbow undergoes reconstruction using a tendon graft to ensure a successful return to sports.
6. A patient with a chronic MCL injury in the elbow that has not responded to conservative treatments opts for surgical reconstruction with a tendon graft.
7. An elderly patient with an MCL tear in the elbow undergoes reconstruction to improve joint stability and alleviate pain.
8. A patient with a history of recurrent MCL injuries in the elbow undergoes reconstruction using a tendon graft to prevent further instability.
9. A young athlete with an MCL tear in the elbow undergoes surgical reconstruction to restore joint stability and allow for a full recovery.