# Open Claviculectomy



## LTibbetts (Aug 10, 2009)

Can anyone give me some advice on this one?

Operation Performed: Right AC Joint excision arthroplasty and acromioplasty

In view of the failure of conservative measures to control his pain, it was elected to decompress the tendons and remove the distal end of the clavicle. He was placed in beach chair position, incision was made over the AC joint and extended this over the anterior aspect of the acromion. Dissection was carried down thru subcut tissues. I then exposed the distal end of the clavicle subperiosteally with sharp dissection and then using the mini Homann retractors exposed the AC joint and then using a small oscillating saw resected the distal 1 cm of clavicle. There were large osteophytes and the superior and inferior surface of the clavicle fragment. This was sent for path. I then used the rasp and contoured the under surface of the end of the clavicle that was remaining and also the acromial side of the AC joint. I then dissected further lateral and then split deltoid anteriorly. Approach to the subacromial space from the lateral portion of the bursa was grossly thickened. This was excised with sharp dissection. The underlying rotator cuff was inspected and were intact. I then proceeded to resect the spur off the anterior acromion using a small osteostomes and a rasp. After the decompression at the subacromial space, the wound was then irrigated and closed...."

I can see where the 23130 was done, but I also see the 23120. I do the facility side and the doc chose only the 23130 for his side. Am I missing something or am I overcoding? Can't I code both and should I? I don't see anywhere in the CCI edits that I can't code them together. Is it because one is incidental to the other? It seems to me that they are in two different compartments of the shoulder (ie AC joint and subacromial space) and therefore are seperately reportable. Can anyone please help to explain what it is that I am missing?


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## coderguy1939 (Aug 10, 2009)

AAOS guidelines state that distal clavicle excision is not included in 23130 but needs to be over 1.0cm.  AMA CPT Assistant gives no guidance that I can find.


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## LTibbetts (Aug 10, 2009)

Does it have to be _over_ 1cm or can it be 1cm _or_ over?


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## coderguy1939 (Aug 10, 2009)

The way it reads in the 2009 AAOS GSD is "distal clavicle excision over 1.0 cm (for eg, 23120)".  I can't find any additional info from the AMA or CMS.  I've seen information on Mumford's that give guidelines anywhere from 8mm and up, but generally falling in the 10mm or greater range.  If your carrier isn't using AAOS guidelines it seems as though you could bill both codes.  Anyone else have additional information on this?


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