CPT® 24342, 24359

Am I stretching in coding 24359 in addition to 24342?

PREOPERATIVE DIAGNOSIS: Left distal biceps rupture.
POSTOPERATIVE DIAGNOSIS: Left distal biceps rupture.
PREOPERATIVE DIAGNOSES: Left distal biceps repair.
ANESTHESIA: General.
EBL: Minimal.

TOURNIQUET TIME: None.
FLUIDS: 1 liter.
DRAINS: None.
IMPLANTS: Arthrex.
INSTRUMENT COUNT: Correct.

INDICATIONS
This is a 54-year-old gentleman who approximately 2-1/2 weeks ago sustained an injury to his left elbow at work with a sudden pop when he was lifting an object. He has pain and swelling with deformity and clinical evidence of a biceps tendon rupture. I have recommended surgical repair. He is in agreement. Risks and benefits including synostosis, stiffness, and neurovascular injury were discussed. All questions were answered and informed consent was obtained.

TECHNIQUE IN DETAIL
The patient was brought to the operating room. He was placed supine on the operating room table where he was given perioperative antibiotics in the form of 2 grams of Ancef as well as general anesthesia. A well-padded tourniquet was placed high on the left axilla. The left upper extremity was prepped and draped in the usual sterile manner. A time-out was performed. A horizontal incision was made approximately 3 cm distal to the antecubital fossa. Careful dissection down through the skin and subcutaneous tissues was performed. The lateral antebrachial cutaneous nerve was protected. The skin was then mobilized and in proximal aspect of the wound the biceps tendon was identified. It was still adherent to the lacertus fibrosis. It was then carefully dissected away. The ruptured end was then debrided. A #2 FiberWire whipstitch was then placed. It was then tucked in the wound and kept moist for later repair. Careful blunt dissection was then performed down to the radius. The forearm was held in a supinated position throughout the entire case at this point and the radial tuberosity was exposed carefully. Blunt retractors were placed both on the lateral as well as the medial side of the radial tuberosity to protect neurovascular structures. A pilot hole was then drilled into the center of the radial tuberosity. This was done with a spade tip needle. This was then subsequently over-drilled with a 7 mm reamer. The stump of the biceps was then retrieved and the sutures were woven through an Arthrex biceps button which was then deployed through the posterior cortex and then used to shuttle the biceps into the groove and was housed in the socket in anatomic fashion. Over this, additional fixation was achieved with a 7 mm Arthrex biotenodesis screw to provide supplemental fixation. Fluoroscopy confirmed placement. The arm was then taken through a range of motion and the biceps was rigidly fixed with no gapping. At this point the excess suture was cut and the wounds copiously irrigated. Layered closure was performed. Marcaine with epinephrine was placed in the skin edges over the wound for adjunct anesthesia. A bulky sterile dressings and a splint applied in approximately 70 degrees of flexion was placed. The patient was then extubated and taken to recovery in stable condition.

In recovery he was noted to be extending his thumb and fingers with no difficulty.