24358

Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); debridement, soft tissue and/or bone, with tendon repair or reattachment

Current Procedural Terminology (CPT) code 24358 represents an open surgical intervention primarily indicated for the treatment of chronic, refractory epicondylitis, commonly referred to as tennis elbow (lateral epicondylitis) or golfer's elbow (medial epicondylitis). This exhaustive procedure involves a tenotomy at the elbow, comprehensive debridement of the diseased soft tissue and/or bone, followed by the definitive repair or reattachment of the tendon. Epicondylitis is characterized by angiofibroblastic tendinosis, a degenerative condition of the common extensor origin (most frequently the extensor carpi radialis brevis for lateral epicondylitis) or the common flexor origin (for medial epicondylitis). When conservative treatments such as rest, activity modification, non-steroidal anti-inflammatory drugs, physical therapy, counterforce bracing, and corticosteroid or orthobiologic injections fail to provide relief after an extended period (typically 6 to 12 months), surgical intervention becomes necessary to restore upper extremity function and alleviate debilitating pain. The surgical technique for CPT 24358 typically begins with the patient placed under regional or general anesthesia. A localized incision is made over the affected medial or lateral epicondyle. The surgeon carefully dissects through the subcutaneous tissues to expose the underlying common extensor or flexor aponeurosis. A longitudinal incision is made in the aponeurosis, allowing the surgeon to identify the underlying degenerative, pathologic tissue, which often appears grey, friable, and edematous compared to the surrounding healthy tendon fibers. The core of the procedure involves the meticulous excision and debridement of this pathologic soft tissue. In addition to soft tissue debridement, the surgeon decorticates or lightly burrs the underlying bone of the epicondyle. This bony debridement serves a dual purpose: it removes any prominent bony osteophytes or exostoses that may be contributing to tendon irritation, and it stimulates a localized bleeding response, which brings marrow-derived elements to the surgical site to foster a robust healing environment. Once the debridement is complete, the crucial reconstructive phase of the operation is performed. The healthy margins of the native tendon are reattached to the prepared bony bed of the epicondyle. This reattachment or repair is typically achieved using transosseous sutures, suture anchors, or side-to-side suturing techniques to close the defect and restore the structural integrity of the aponeurosis. The wound is then irrigated, hemostasis is obtained, and the incision is closed in a layered fashion. A compressive dressing and often a splint are applied to immobilize the elbow and protect the repair during the initial phases of postoperative rehabilitation.

Clinical Indications

  • Chronic lateral epicondylitis (tennis elbow) refractory to at least 6 months of comprehensive conservative management.
  • Chronic medial epicondylitis (golfer's elbow) failing physical therapy, activity modification, and injection therapy.
  • Severe, localized elbow pain at the epicondyle resulting in significant functional impairment of the upper extremity.
  • Magnetic resonance imaging (MRI) or musculoskeletal ultrasound evidence of severe tendinosis, high-grade partial tearing, or extensive degenerative changes in the common extensor or flexor origin.

Procedure Steps

  1. Administration of regional block or general anesthesia, followed by proper patient positioning and sterile prep and drape of the affected upper extremity.
  2. Creation of a longitudinal or curvilinear incision directly over the affected lateral or medial epicondyle.
  3. Dissection through the subcutaneous tissue to identify and expose the common extensor aponeurosis (lateral) or common flexor aponeurosis (medial).
  4. Incision of the fascia and identification of the degenerated, angiofibroblastic tendinotic tissue (often involving the extensor carpi radialis brevis).
  5. Radical excision and thorough debridement of all pathologic soft tissue until healthy tendon margins are reached.
  6. Preparation of the epicondyle by decortication, rasping, or burring of the bone to remove osteophytes and stimulate a vascular healing response.
  7. Repair of the tendon defect and reattachment of the healthy tendon to the prepared bony bed using suture anchors or transosseous sutures.
  8. Thorough copious irrigation of the surgical site and confirmation of meticulous hemostasis.
  9. Layered anatomic closure of the fascial, subcutaneous, and dermal layers.
  10. Application of a sterile surgical dressing and application of a posterior splint or hinged elbow brace to protect the repair.

Coding Guidelines

  • Do not report CPT 24358 in conjunction with CPT 24357 (percutaneous tenotomy) for the same elbow.
  • CPT 24358 inherently includes debridement of soft tissue and bone; therefore, separate debridement codes should not be reported for the same surgical site.
  • Append laterality modifiers RT (Right) or LT (Left) to designate the side of the procedure.
  • If the procedure is performed bilaterally during the same operative session, append modifier 50.
  • This code carries a 90-day global period. All routine preoperative, intraoperative, and postoperative care provided by the operating surgeon is included in this global surgical package.
  • The use of suture anchors, screws, or other implants for reattachment is considered an integral part of the procedure and is typically reported by the facility, not separately by the surgeon.

Associated ICD-10 Codes