How To Use CPT Code 24635

CPT code 24635 describes the open treatment of a Monteggia type of fracture dislocation at the elbow, which involves a fracture of the proximal end of the ulna with dislocation of the radial head. 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 24635?

CPT code 24635 is used to describe the open treatment of a specific type of fracture dislocation at the elbow known as a Monteggia type. This type of fracture involves a fracture of the proximal end of the ulna, one of the bones in the forearm, along with dislocation of the radial head, the other forearm bone. The procedure includes internal fixation, which may involve the use of wires and plates to stabilize the fracture and dislocation.

2. Official Description

The official description of CPT code 24635 is: ‘Open treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), includes internal fixation, when performed.’

3. Procedure

The open treatment of a Monteggia type of fracture dislocation at the elbow involves several steps:

1. The patient is appropriately prepped and anesthetized.
2. An incision is made over the dislocation site, and the surrounding muscles are dissected.
3. The site of the injury, with the fracture of the proximal end of the ulna and dislocation of the radial head, is identified.
4. The fracture and dislocation are reduced, meaning the bones are realigned to their normal position.
5. If necessary, wires and plates may be inserted to stabilize the reduction.
6. The alignment is confirmed with imaging.
7. The area is irrigated, checked for bleeding, and any instruments are removed.
8. The incision is closed.

4. Qualifying circumstances

CPT code 24635 is used for patients who have a Monteggia type of fracture dislocation at the elbow, specifically a fracture of the proximal end of the ulna with dislocation of the radial head. The procedure is performed by a healthcare professional and includes internal fixation, such as the use of wires and plates, when necessary.

5. When to use CPT code 24635

CPT code 24635 should be used when performing the open treatment of a Monteggia type of fracture dislocation at the elbow, as described in the official description. It is important to ensure that the specific criteria for this code are met, including the presence of a fracture of the proximal end of the ulna with dislocation of the radial head, and the use of internal fixation if required.

6. Documentation requirements

To support a claim for CPT code 24635, the healthcare professional must document the following information:

• Patient’s diagnosis of a Monteggia type of fracture dislocation at the elbow
• Details of the procedure performed, including the specific fracture and dislocation involved
• Description of the internal fixation used, if applicable
• Date of the procedure
• Confirmation of reduction and alignment with imaging
• Any additional relevant information, such as complications or additional procedures performed
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT code 24635, it is important to ensure that the procedure performed meets the specific criteria outlined in the official description. The use of internal fixation, such as wires and plates, should be documented if applicable. It is also important to follow any additional guidelines or requirements set forth by the payer or coding guidelines.

8. Historical information

CPT code 24635 was added to the Current Procedural Terminology system on January 1, 1990. On January 1, 2008, there was a code change that expanded the description to include the option of internal or external fixation.

9. Examples

1. A patient presents with a Monteggia type of fracture dislocation at the elbow, with a fracture of the proximal end of the ulna and dislocation of the radial head. The healthcare professional performs an open treatment procedure, reducing the fracture and dislocation and using internal fixation with wires and plates to stabilize the bones.
2. Another patient has a similar Monteggia type of fracture dislocation at the elbow, but the healthcare professional determines that internal fixation is not necessary. The procedure involves reducing the fracture and dislocation and confirming alignment with imaging.
3. A third patient presents with a Monteggia type of fracture dislocation at the elbow, but the healthcare professional determines that the fracture is not amenable to open treatment. Instead, a closed reduction procedure is performed to realign the bones without the use of internal fixation.