# Shoulder compartments



## skorkfranks (Dec 31, 2009)

Quick question for the group, I was told at a seminar that the shoulder has different compartments (like the knee) and that these compartments are considered different sites. I am having trouble finding a diagram, etc. that shows the different shoulder compartments. I have a great knee compartment diagram that came with the COSC practicuum and was wondering if there was anything like this diagram for the shoulder area. I've been searching for this information, but to no avail. Thanks!!!!


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## WulbernC (Dec 31, 2009)

skorkfranks said:


> Quick question for the group, I was told at a seminar that the shoulder has different compartments (like the knee) and that these compartments are considered different sites. I am having trouble finding a diagram, etc. that shows the different shoulder compartments. I have a great knee compartment diagram that came with the COSC practicuum and was wondering if there was anything like this diagram for the shoulder area. I've been searching for this information, but to no avail. Thanks!!!!



The person who gave that seminar should have provided the backup for the statement made. At this time, the shoulder (unlike the knee) is not broken down into compartments. It does contain different structures that may be considered separate areas, i.e. subacromial vs labral. However, according to the November 1 2008 CPT Assistant: 

"_*Question*: Can you explain how to code arthroscopies on joints other than the knee? The knee is reported by compartments (medial, lateral, or patello-femoral). It is not clear how the other joints are reported. It appears that the shoulder is coded by whether the work is done anteriorly or posteriorly. What about the wrist and ankle and so forth?_

*Answer:*_You are correct that the knee has more than one compartment, and in some cases modifier 59, Distinct procedural service, allows for reporting of multiple procedures when more than one compartment is the site of distinct procedures. However, musculoskeletal system endoscopy/ arthroscopy reporting is generally not based on the compartment(s) in a given joint. While the knee has three compartments, the ankle has only one compartment. The endoscopy/arthroscopy subsection of the CPT codebook is arranged by specific anatomy (eg, shoulder, elbow, wrist, and ankle) with code descriptor language delineating procedural service(s) of the intra-articular structure(s) unique to each joint. There are no endoscopy/arthroscopy codes that divide a joint by exposure (eg, anterior, posterior, medial, or lateral) even though the procedure described may have a typical approach. For reporting purposes, if multiple exposures are required that involve more work than the usual joint procedure, modifier 22, Increased procedural services, may be used. Supporting documentation (eg, procedure report) should be submitted._"

Unless there is something new out there, which I've not been able to find, I would stick with the guidance in that CPT Assistant article.

I hope this is helpful!


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## coderguy1939 (Dec 31, 2009)

Take a look at this for AAOS's take on shoulder areas:

http://www2.aaos.org/aaos/archives/bulletin/apr06/coding2.asp


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## mbort (Dec 31, 2009)

skorkfranks said:


> Quick question for the group, I was told at a seminar that the shoulder has different compartments (like the knee) and that these compartments are considered different sites. I am having trouble finding a diagram, etc. that shows the different shoulder compartments. I have a great knee compartment diagram that came with the COSC practicuum and was wondering if there was anything like this diagram for the shoulder area. I've been searching for this information, but to no avail. Thanks!!!!



yikes................


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## skorkfranks (Jan 4, 2010)

Thanks!!! This is exactly what I was looking for!!! Thank goodness for these boards. I spend half my day in "yikes" mode.


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## sanchize5 (Jun 1, 2018)

*coding the shoulder*



coderguy1939 said:


> Take a look at this for AAOS's take on shoulder areas:
> 
> http://www2.aaos.org/aaos/archives/bulletin/apr06/coding2.asp



Does anyone have an updated link for this? The one here is not available.


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## Orthocoderpgu (Jun 1, 2018)

*Insurance companies don't separate the shoulder into compartments*

It's been my experience that insurance companies don't separate the shoulder into compartments like the knee is. 

The president of AAOS has met with CMS multiple times in order to convince them that the shoulder has anatomically separate structures, but to little avail. After their last meeting CMS agreed to allow 29823 with high restrictions and the NCCI surgical policy manual specifically states that CMS considers the shoulder to be one anatomic structure, totally ignoring the president of AAOS. 

My experience has been that insurance companies have latched on to this information, since it's totally in their favor even though it ignores reality, and bundle procedures accordingly.

Don't be surprised if insurance companies don't follow the rules for coding shoulder compartments, but I hope you do.


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