24357

Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); percutaneous

The CPT code 24357 describes a percutaneous tenotomy procedure performed on the elbow, targeting either the lateral or medial epicondyle. This surgical intervention is primarily indicated for patients suffering from chronic, recalcitrant epicondylitis, commonly known as tennis elbow (lateral epicondylitis) or golfer's elbow (medial epicondylitis), who have not responded to conservative treatments such as physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, and bracing. The goal of the procedure is to relieve tension, release degenerative or scarred tendon tissue, and stimulate a localized healing response to encourage the formation of healthy tendon fibers. During the procedure, the patient is appropriately positioned, and local anesthesia is administered to the affected elbow region. The physician makes a tiny puncture incision or introduces a specialized needle or percutaneous cutting instrument through the skin directly over the point of maximum tenderness at the lateral or medial epicondyle. Unlike an open procedure, there is no large incision or direct visualization of the deep tissues. Instead, the provider relies on anatomical landmarks and tactile feedback, sometimes aided by ultrasound guidance (which should be coded separately if properly documented and indicated), to repeatedly fenestrate or partially transect the diseased common extensor or flexor tendon origin. This process disrupts the angiofibroblastic hyperplasia associated with chronic tendinosis, releasing the tight fascial bands and inducing micro-trauma that triggers the body's natural inflammatory and healing cascade. Once the tenotomy is complete, the instrument is withdrawn, and the puncture site is covered with a sterile dressing or a simple bandage. Stitches are rarely required due to the percutaneous nature of the approach. Post-operatively, the patient is typically placed in a supportive splint or sling and advised on a specific rehabilitation protocol to gradually restore range of motion and strength while the tendon heals. This minimally invasive technique offers a shorter recovery time and less soft tissue morbidity compared to open debridement and repair procedures.

Clinical Indications

  • Chronic lateral epicondylitis (tennis elbow) failing conservative management.
  • Chronic medial epicondylitis (golfer's elbow) failing conservative management.
  • Recalcitrant tendinosis of the common extensor origin.
  • Recalcitrant tendinosis of the common flexor origin.
  • Persistent elbow pain at the epicondyle resulting in significant functional impairment.

Procedure Steps

  1. The patient is positioned comfortably, typically supine or seated, with the affected elbow flexed and supported.
  2. The skin over the targeted lateral or medial epicondyle is prepped and draped in a sterile fashion.
  3. Local anesthetic (e.g., lidocaine or bupivacaine) is infiltrated into the subcutaneous tissue and down to the epicondylar periosteum.
  4. A small gauge needle, scalpel blade (e.g., #11), or specialized percutaneous tenotomy instrument is introduced through the skin.
  5. The instrument is advanced to the common extensor tendon origin (lateral) or common flexor tendon origin (medial).
  6. Multiple passes or fenestrations are made into the diseased tendon tissue to release tension and break up scar tissue.
  7. The instrument is carefully withdrawn after ensuring adequate release.
  8. Hemostasis is achieved with direct pressure.
  9. A sterile adhesive bandage or light dressing is applied over the puncture site.

Coding Guidelines

  • Do not report 24357 in conjunction with open elbow tenotomy or debridement codes (24358, 24359) for the same elbow.
  • If ultrasound guidance is used to perform the percutaneous tenotomy, it may be reported separately using the appropriate imaging guidance code (e.g., 76942), provided all documentation requirements are met.
  • Report 24357 only once per elbow per session, regardless of the number of passes made into the tendon.
  • Use appropriate anatomical modifiers (e.g., RT for right, LT for left) to indicate the specific elbow treated.
  • If bilateral procedures are performed, append modifier 50 to the procedure code.

Associated ICD-10 Codes