CPT code 24359 – Open elbow tenotomy with tendon repair

Key takeaways

CPT code 24359 covers open elbow tenotomy with soft tissue and/or bone debridement plus tendon repair or reattachment. Use 24358 for open debridement without repair and 24357 for percutaneous tenotomy.

The primary diagnosis codes are M77.11 (right) and M77.12 (left) for lateral epicondylitis, and M77.01 (right) and M77.02 (left) for medial epicondylitis. Unspecified laterality (M77.10) is a common denial trigger.

The CMS global period for CPT 24359 is 90 days. Routine post-op visits billed separately in that window without the correct modifier are rejected.

Pabau’s claims management software scrubs each claim for missing or invalid details before it goes out through Claim.MD. That cuts rework on surgical codes like 24359.

CPT code 24359: Definition and clinical description

CPT code 24359 describes an open tenotomy at the lateral or medial elbow, with soft tissue and/or bone debridement and tendon repair or reattachment.

It sits in the musculoskeletal part of the AMA CPT Surgery section. The code falls under repair, revision, and/or reconstruction procedures on the humerus and elbow (24300-24498).

Orthopedic practices, sports medicine practices, and ambulatory surgery centers bill it for tennis elbow or golfer’s elbow after documented failure of conservative care.

The procedure involves an open approach, debridement of degenerative tendon tissue and any diseased bone, repair or reattachment of the tendon origin, and closure. On the lateral side, that is the common extensor origin. On the medial side, it is the flexor-pronator origin.

For coders, knowing what the operative note must document separates a clean first-pass claim from a denial. Bone debridement is part of the descriptor, so it does not call for a separate code.

Official CPT 24359 descriptor and procedure overview

The American Medical Association (AMA) maintains the official CPT descriptor for 24359. It reads: Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer’s elbow); debridement, soft tissue and/or bone, open with tendon repair or reattachment. Check it against the AMA CPT codebook for the billing year, because descriptors can change in annual updates.

The operative note supporting this code must document the following elements:

• Confirmed diagnosis with laterality (right or left elbow, lateral or medial epicondyle)
• Open surgical approach (skin incision, deep dissection to the epicondyle)
• Identification and debridement of degenerative or torn tendon tissue
• Whether bone was debrided (included in the code, but it should be documented)
• Repair or reattachment of the tendon origin, including the fixation method
• Wound closure technique and post-op plan

Missing any of these elements, especially laterality and the description of the tendon repair, is a direct path to a documentation-based denial. A note that describes open debridement without repair or reattachment supports 24358, not 24359.

CPT code 24359 vs. 24358 and 24357: How to choose the right code

The 24357-24359 family covers tenotomy for epicondylitis at the lateral or medial elbow. Each code reflects a different approach and extent of repair. The operative report decides which one applies.

The critical distinction is tendon repair or reattachment versus debridement only. Code 24357 is done percutaneously, with no open debridement or repair. Code 24358 is an open debridement that leaves the tendon origin unrepaired. Code 24359 requires the surgeon to repair or reattach the tendon after the open debridement.

An open note describing debridement only maps to 24358, and a percutaneous release maps to 24357. Two documented facts settle the choice, as the decision path below shows.

ICD-10 diagnosis codes that support CPT 24359

Payers require an ICD-10-CM diagnosis code that establishes medical necessity for CPT code 24359. Lateral repairs take the lateral epicondylitis codes under M77.1, and medial repairs take the medial epicondylitis codes under M77.0. Each one carries a laterality requirement.

Always use a lateralized code: M77.11 or M77.12 for lateral repairs, M77.01 or M77.02 for medial ones. Payers, including Medicare, can flag an unspecified code such as M77.10 on a surgical claim as a medical necessity concern.

The diagnosis code must also match the side documented in the operative report. A right-elbow ICD-10 code on a left-elbow operative note is a payer audit trigger.

Medicare reimbursement rate for CPT code 24359

Medicare reimburses CPT code 24359 under the CMS Physician Fee Schedule (MPFS). Payment differs between facility (hospital outpatient, ASC) and non-facility (office) settings. It also varies by locality through the Geographic Practice Cost Index (GPCI). RVUs and the conversion factor change every year. Check the current amount in the CMS MPFS Look-Up Tool before you quote or post a rate.

Where to find the RVU breakdown for 24359

The Look-Up Tool lists the work, practice expense, and malpractice RVUs for 24359, with facility and non-facility totals for your locality. It also shows the global period and the payment indicators for modifiers such as 50, 80 and 82. Commercial payers set their own rates by contract, so check each payer’s fee schedule separately.

Modifiers commonly used with CPT code 24359

Modifiers clarify the circumstances under which CPT code 24359 was performed. Selecting the wrong modifier, or omitting a required one, is a common source of claim rejections and audits. The table below lists the modifiers most relevant to 24359 billing.

Verify with each payer whether modifier 50 or separate line items with RT/LT are preferred for bilateral procedures. Medicare generally allows modifier 50 on musculoskeletal surgical codes, but commercial payers often have conflicting requirements. Check the payer’s billing guidelines before submission.

Global period and post-operative billing for CPT 24359

CPT code 24359 carries a 90-day global period under CMS, confirmed in the CMS Global Surgery data file. The payment for 24359 bundles the pre-operative visit on the day before or day of surgery and the intraoperative service. It also covers all routine post-operative care for 90 calendar days.

A common error with global packages is billing evaluation and management (E&M) codes for routine post-op visits inside the window. Under standard medical billing rules, those visits are already paid as part of 24359. Billed separately without a modifier, they are denied.

What is bundled into the global package:

• Pre-operative exam on the day of or day before surgery
• Intraoperative services (the 24359 procedure itself)
• All routine post-op office visits for 90 days
• Suture removal and standard wound care within the 90-day window
• Treatment of post-op complications not requiring a return to the OR

What remains separately billable during the global period:

• A new or unrelated condition with modifier 24 appended to the E&M code
• A staged related procedure (modifier 58)
• An unrelated surgical procedure (modifier 79)
• Diagnostic tests ordered for unrelated conditions

Prior authorization and payer requirements for epicondylitis surgery

Most commercial payers and Medicare Advantage plans require prior authorization before approving CPT code 24359. Medicare fee-for-service generally does not require PA for this code, but check current CMS requirements. Medicare still reviews medical necessity when the claim is adjudicated. Regardless of payer type, maintaining strong documentation of the conservative treatment pathway protects reimbursement.

Step-therapy protocols for epicondylitis surgery vary by payer, so check each one as part of your medical billing compliance routine. Most ask for the following before authorizing surgery:

• Minimum 6-12 weeks of documented physical therapy or occupational therapy
• At least one corticosteroid injection with documented outcome
• Activity modification and orthotic bracing trials where clinically indicated
• Diagnostic imaging (usually MRI or ultrasound) confirming tendon pathology
• Attending physician attestation that surgery is the next appropriate step

When PA is required, submit the operative plan with the lateralized ICD-10-CM code and the CPT code (24359) together. A mismatch between the authorized code and the billed code is a straightforward denial that requires an appeal rather than a simple resubmission.

Documentation requirements for a clean 24359 claim

A clean claim submission for CPT code 24359 requires the operative report to address each of the following elements. Coders should review the note before charge entry, not after a denial is received.

• Confirmed diagnosis with laterality: State the condition and side explicitly in the operative indication, for example “lateral epicondylitis, right elbow”
• Failure of conservative treatment: Reference the prior non-surgical care in the pre-op note (duration, modalities, patient response)
• Surgical approach: Describe the incision location and the approach to the lateral or medial epicondyle
• Tendon pathology encountered: Document the condition of the extensor or flexor-pronator origin (degenerative tissue, partial tear, avulsion)
• Debridement performed: State whether soft tissue, bone, or both were debrided
• Tendon repair or reattachment: Describe the repair and how the tendon was fixed, because this separates 24359 from 24358
• Wound closure: Layer-by-layer closure description
• Post-op plan: Immobilization, follow-up timeline, rehabilitation protocol

An auditor will code a note as 24358 when it documents open debridement without describing repair or reattachment of the tendon origin. That holds whatever the surgeon intended. A percutaneous release supports only 24357, so precise operative language decides which code is defensible.

Common denial reasons for CPT code 24359 and how to avoid them

Denials for CPT code 24359 cluster around a predictable set of errors. Catching them before submission costs far less than working appeals after the fact. In orthopedic practices, denial management starts with front-end edits at charge capture.

• Wrong code selected (24357/24358 vs. 24359): The operative note describes open debridement or a percutaneous release without tendon repair or reattachment. Review the note and query the surgeon before changing the code.
• Missing or unspecified ICD-10 laterality: M77.10 (unspecified) on a surgical claim. Use the lateralized code (M77.11, M77.12, M77.01 or M77.02) that matches the operative site.
• Insufficient conservative care documentation: The chart lacks evidence of physical therapy, injections, or bracing prior to surgery. Establish a pre-authorization documentation checklist for all elbow repair cases.
• NCCI bundling conflict: Billing 24359 with 24357 or 24358 on the same elbow and date. These codes describe alternative versions of the same procedure, so National Correct Coding Initiative (NCCI) edits bundle them. Bill only the code that matches the most extensive service performed.
• Modifier omission on bilateral same-session procedures: Billing both elbows without modifier 50 or without RT/LT laterality modifiers can trigger an automatic clearinghouse edit.
• Global period overlap: Billing a post-op E&M visit during the 90-day global period without modifier 24 or 79. Set a global period tracker for each surgical case.
• Prior auth not obtained or expired: Claim submitted after the authorization window expired or before PA was secured. Build authorization expiration alerts into the practice management workflow.

How claims management software reduces errors on CPT 24359

Static code lookup tools identify what 24359 means. Orthopedic and sports medicine practices need a system that applies that knowledge before a claim leaves the building. Laterality mismatches, missing modifiers, and missed global periods cost far less to catch at charge entry than to appeal.

Pabau’s claims management software scrubs every claim for missing or invalid details before it leaves Pabau. For a code like 24359, a clean claim often turns on two checks. The ICD-10 laterality has to match the operative side, and the modifier has to be populated.

A rejected claim is marked “Needs action,” so your billing team can fix and resubmit it from one place. For the wider picture, see how revenue cycle management ties claims, payments, and denials together.

For Medicare and commercial payers, Pabau sends CMS-1500 claims through its Claim.MD integration and checks eligibility before the visit. Payments post straight from ERA files, so your team skips manual reconciliation across separate systems. When a payer does deny a 24359 claim, the remittance carries a reason code. Our guide to medical billing denial codes explains what each one means.

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Pabau scrubs each claim for missing or invalid details before it leaves, then submits it through our Claim.MD integration. Your team spends less time on rework and more time on care.

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Conclusion

Clean billing for CPT code 24359 starts with the operative note. When the surgeon describes the tendon repair or reattachment and names the side, the code, diagnosis and modifiers follow from it. When the note leaves the repair out, an auditor reads it as 24358, and no claim edit can change that.

So the change worth making is upstream. Agree a short operative-note checklist with your surgeons, then let charge capture check laterality and modifiers before each claim goes out. Book a demo to see how Pabau catches those errors on elbow surgical claims before they reach the payer.

Continue your research

Want to understand how clearinghouse integration reduces surgical claim errors? Claim.MD clearinghouse guide covers how 837P submission and ERA matching work in practice.

Need to understand what makes a claim clean before it reaches the payer? Insurance eligibility verification explains how real-time checks prevent downstream denials on surgical cases.

Looking for context on how the 837 file format supports elbow surgical billing? 837 claim file guide walks through the EDI transaction structure used for outpatient procedure billing.

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