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Official Description

Reconstruction lateral collateral ligament, elbow, with tendon graft (includes harvesting of graft)

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 24344 involves the reconstruction of the lateral collateral ligament (LCL) of the elbow using a tendon graft, which includes the harvesting of the graft itself. The LCL is a critical ligament that provides stability to the elbow joint, connecting the lateral epicondyle of the humerus to the annular ligament of the radius. This ligament plays a vital role in maintaining the proper alignment and function of the elbow, particularly during activities that involve arm movement and weight-bearing. Injuries to the LCL can occur due to acute trauma or chronic stress, often manifesting in conditions such as tennis elbow. The reconstruction procedure is indicated when the LCL is severely damaged and cannot be repaired through simpler methods. During the surgery, a tendon graft is harvested, typically from the palmaris longus, although other tendons such as the plantaris, Achilles, or hamstring may also be utilized. The harvested graft is then meticulously prepared and secured to the lateral epicondyle of the humerus and the radial head, restoring the integrity and function of the elbow joint.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The reconstruction of the lateral collateral ligament (LCL) of the elbow using a tendon graft is indicated for the following conditions:

  • Severe LCL Injury: This procedure is performed when there is a significant tear or rupture of the LCL that cannot be adequately repaired through simpler surgical techniques.
  • Chronic Instability: Patients experiencing chronic instability of the elbow joint due to LCL damage may require reconstruction to restore stability and function.
  • Associated Conditions: The procedure may also be indicated in cases where the LCL injury is associated with other conditions, such as tennis elbow, which can exacerbate the instability of the elbow joint.

2. Procedure

The procedure for reconstructing the lateral collateral ligament (LCL) of the elbow with a tendon graft involves several detailed steps:

  • Step 1: An incision is made over the lateral humeral epicondyle and is extended distally across the elbow joint to the proximal ulna. This incision allows access to the underlying structures of the elbow.
  • Step 2: The fascia overlying the anconeus and extensor carpi ulnaris muscles is incised to expose the deeper tissues. Care is taken to preserve the integrity of surrounding neurovascular structures during this dissection.
  • Step 3: The joint capsule is exposed by elevating the overlying tendons and muscles. The LCL is then identified and the joint capsule is incised to facilitate access to the ligament.
  • Step 4: The radial head is exposed, and the LCL is released from its attachment at the lateral epicondyle. This step is crucial for allowing the surgeon to assess the extent of the injury and prepare for reconstruction.
  • Step 5: The damaged tissue of the LCL is debrided, and any necrotic or unhealthy tissue is excised to prepare for the reconstruction.
  • Step 6: Drill holes are placed in the lateral epicondyle, and the LCL is reattached using sutures. This step is essential for restoring the ligament's attachment to the bone.
  • Step 7: If necessary, local tissue, typically a split anconeus fascia transfer, is used to reinforce the LCL repair. This additional support can enhance the stability of the reconstruction.
  • Step 8: In cases where a distal repair is required, the LCL is released from the radial head and repaired in a similar fashion, ensuring that the entire ligament is reconstructed effectively.
  • Step 9: For the tendon graft reconstruction, a tendon graft is harvested, usually from the palmaris longus, but may also be taken from the plantaris, Achilles, or hamstring tendons. The graft is then trimmed to the appropriate size and shape.
  • Step 10: The graft tendon is attached to the lateral epicondyle of the humerus and the radial head using a fixation device, such as a screw or button, to secure it in place and restore the function of the LCL.

3. Post-Procedure

After the reconstruction of the lateral collateral ligament, patients typically undergo a period of rehabilitation to ensure proper healing and regain strength and mobility in the elbow. Post-procedure care may include immobilization of the elbow in a brace or splint to protect the surgical site during the initial healing phase. Physical therapy is often initiated to promote range of motion and strengthen the surrounding muscles. The expected recovery time can vary based on the extent of the injury and the individual patient's healing process, but patients are generally advised to follow up with their healthcare provider to monitor progress and address any complications that may arise.

Short Descr RECONSTRUCT ELBOW LAT LIGMNT
Medium Descr RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT
Long Descr Reconstruction lateral collateral ligament, elbow, with tendon graft (includes harvesting of graft)
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P5B - Ambulatory procedures - musculoskeletal
MUE 1
CCS Clinical Classification 162 - Other OR therapeutic procedures on joints
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
62 Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
GC This service has been performed in part by a resident under the direction of a teaching physician
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
Date
Action
Notes
2002-01-01 Added First appearance in code book in 2002.
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