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Orthopedic Coding Alert

Guest Column:

David V. Janeway, MD--Tennis and Golfers' Elbow: They're Not Just the Participant's Problem Anymore

The surgeon's notes will give you a hint about the right codes to report If your head spins when you-re faced with the various codes for medial and lateral epicondylitis procedures, we-ve got some solid advice for you.

When you have to decide among CPT codes 24350-24356, you may wonder which codes describe each surgical procedure--so many codes, for what seems to be one little problem, right? To understand why it is so important to have all of those codes available to you, you should get to know a little elbow anatomy, and you-ll find the code choice much easier. Elbow Terminology Translates Into Coding Terms The elbow is a sophisticated hinged joint involving the ulna, radius and the humerus. The ulno-humeral joint allows flexion and extension. The radio-capitellar (humeral) joint, when combined with the distal radio-ulnar joint in the wrist, allow rotation in the elbow, also known as pronation and supination. The ligaments of the elbow include the medial and lateral collateral ligaments.

Although many muscles originate or insert around the elbow, those involved in tennis elbow and golfers- elbow include the extensor muscles on the radial (lateral) side and the flexors on the ulnar (medial) side of the elbow, respectively. Know the Differences Between Golfers- Elbow and Tennis Elbow Lateral epicondylitis, or tennis elbow, is related to chronic repetitive micro trauma to the extensor carpi radialis brevis muscle (ECRB). It was initially described as an injury occurring as the result of poor backhand technique--thus the origin of the term -tennis elbow.- It usually affects patients in the fourth to fifth decades of life.

What happens: Micro tearing occurs at the origin of the ECRB at the lateral epicondyle. This, coupled with a poor blood supply, can lead to poor healing and refractory symptoms.

Lateral epicondylitis is 10 times more common than medial epicondylitis, a similar process affecting the medial side of the elbow, perhaps more easily recognized as -golfers- elbow.- However, any activity involving overuse or abnormal use of the flexor or extensor muscles can cause these conditions. Despite the sporty-sounding names, these conditions occur more frequently in non-athletes than in athletes.

Initial treatment for these conditions typically includes -RICE---Rest, Ice, Compression, and Elevation. Surgeons may also recommend non-steroidal anti-inflammatory medicines, and casting may be helpful acutely.

Surgeons may also recommend local steroid injections, oral steroids, stretching and strengthening of the involved muscles through a home exercise program (HEP) or formal physical therapy, but despite appropriate conservative management, some patients require more aggressive treatment. Know the Epicondylitis Treatments, Codes Extracorporeal shock wave treatment (ECSWT) is an FDA-approved treatment for refractory lateral epicondylitis that uses high-frequency sound waves to stimulate healing in soft tissues.

Despite FDA approval, there is no Category [...]

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