# Shoulder Procedure



## alk@APS (Jan 11, 2018)

OPERATION PERFORMED:
1.   Right revision shoulder arthroplasty with removal of hardware.
2.   Right shoulder extensive debridement with intraoperative cultures.
3.   Right shoulder implantation of cement spacer for possible two-stage revision.

Billing to BCBS, prosthesis was removed from shoulder and a spacer implanted for a later staged revision. New procedure for me, doctor wants to bill a 23474. Any help I can get  would be appreciated!!


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## Orthocoderpgu (Jan 11, 2018)

*23474 is for a revision procedure*

A revision is when the surgeon takes out the previously placed components (humeral and glenoid) and then places new ones in the same surgical session. And that would be coded 23474.

According to your note, he is taking out the components but not replacing them. So this would not be your code.

Per your note he seems to be placing an antibiotic spacer that is placed temporarily for infection. Usually it's left in for six weeks and then the shoulder components are put back in.

That is as far as I can help with what was given but 23474 is not your code for this.


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## hblakeman (Jan 11, 2018)

*23335 and 11981*

I have documentation from AAPC National Conference 2014 in which Ruby O'Brochta-Woodward's presentation states that there is no current guidance for shoulder staged revision, however based on the consistency between the hip and knee she suggest to follow the same thought process.  So for the 1st stage, code removal of prosthesis -23335 and insertion of antibiotic cement spacer -11981.


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## Orthocoderpgu (Jan 11, 2018)

*shoulder revision*

That's the way I would code it too.


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## alk@APS (Jan 15, 2018)

Thanks all!


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