# Help coding calcific tendinitis



## LTibbetts (Nov 4, 2008)

I have an op note that states that they did an excision on the calcification of the shoulder but they also did acromioplasty. I am having a hard time figuring out which code(s). I am torn between 23130 and 23415. The 23130 is only a partial acromioplasty but the 23415 mentions the ligament release so I am wondering if either or both codes are even accurate. Please, any advice or help would be appreciated.

Here is some of the op note:

The bursa was thickened and acutely inflammed overlying the rotator cuff. This was excised in the superior aspect. The underlying rotator cuff was grossly inflamed with a large calcific deposit at the junction between the supraspinatus and infraspinatus tendons. There was a large oteophyte off the anterior acromion, and this was resected with an osteotome. There was a large osteophyte off the AC joint. This was removed with a rasp. I then made a small incision with a 15 blade, and the calcific deposit was curetted and debride from the tendon. There was considerable degeneration of this section of the rotator cuff tendon. I did excise some of the tendon that was abvioulsy dissected. I then carried out a repair in a side-to-side fashion with interrupted #1 vicryl sutures. The wound was copiously irrigated. I injected 10 ml of ropivacaine into the rotator cuff and then another 10 ml into the subcutaneous tissues.


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## cinnamon (Nov 4, 2008)

LeslieTibbetts said:


> I have an op note that states that they did an excision on the calcification of the shoulder but they also did acromioplasty. I am having a hard time figuring out which code(s). I am torn between 23130 and 23415. The 23130 is only a partial acromioplasty but the 23415 mentions the ligament release so I am wondering if either or both codes are even accurate. Please, any advice or help would be appreciated.
> 
> Here is some of the op note:
> 
> The bursa was thickened and acutely inflammed overlying the rotator cuff. This was excised in the superior aspect. The underlying rotator cuff was grossly inflamed with a large calcific deposit at the junction between the supraspinatus and infraspinatus tendons. There was a large oteophyte off the anterior acromion, and this was resected with an osteotome. There was a large osteophyte off the AC joint. This was removed with a rasp. I then made a small incision with a 15 blade, and the calcific deposit was curetted and debride from the tendon. There was considerable degeneration of this section of the rotator cuff tendon. I did excise some of the tendon that was abvioulsy dissected. I then carried out a repair in a side-to-side fashion with interrupted #1 vicryl sutures. The wound was copiously irrigated. I injected 10 ml of ropivacaine into the rotator cuff and then another 10 ml into the subcutaneous tissues.



**

You can code all procedures using those cpt. If outpatient you code the cpt and ICD-9 vol 3 codes and with Inpatient Only you would code use ICD book volume 1,2,&3 with using the Vol 3 procedures codes. 

If you hav calcification you should code those as well as the acromioplasty  and the ligament release . Sometimes in coding cpt, u may have to use the same code more than once depending on what the code book rules are to a particular code and also use your modifier -51 if more than one procedure or what it allows you to use. Good luck!!


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## mbort (Nov 4, 2008)

Leslie,

Which code did you plan to use for the side to side rotator cuff repair? you may not need to worry about it due to bundling 

Mary


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## LTibbetts (Nov 5, 2008)

I wasn't sure what to do about the side-to-side code. I am still trying to figure out what is bundled with what. I was hoping to hear back from you specifically, though, as to what you thought about it. I value your advice and input. We are critical access also so I didn't know if that factured in as well.


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## mbort (Nov 5, 2008)

LeslieTibbetts said:


> I wasn't sure what to do about the side-to-side code. I am still trying to figure out what is bundled with what. I was hoping to hear back from you specifically, though, as to what you thought about it. I value your advice and input. We are critical access also so I didn't know if that factured in as well.



Leslie I sent you a private message 
Mary


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## LTibbetts (Nov 6, 2008)

*Tibbs20*

Mary, I just spoke to someone that used to code ortho here that I had also asked about this op note and she came up with 23130 only, stating that there wasn't actually a rotator cuff repair done. She also came up with 23000 but since it is included with 23130, she dropped it and just went with the 23130. Do you agree? I thought that the side-to-side repair and the fact that some of the tendon was excised would indicate a repair.


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## mbort (Nov 6, 2008)

LeslieTibbetts said:


> Mary, I just spoke to someone that used to code ortho here that I had also asked about this op note and she came up with 23130 only, stating that there wasn't actually a rotator cuff repair done. She also came up with 23000 but since it is included with 23130, she dropped it and just went with the 23130. Do you agree? I thought that the side-to-side repair and the fact that some of the tendon was excised would indicate a repair.



The op note justifies using the 59 modifier for the 23000.  I agree that the 23000 is the better choice for the side to side repair.

so for this case the codes would be:
23130
23000-59


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