# Reverse total shoulder with repair of greater and lesser tuberosities fx



## cayoung (Mar 15, 2016)

I'm working on a claim for a reverse total shoulder 23472 to treat a 4 part fracture dislocation of the LT proximal humerus.  In addition, Dr repaired the greater and lesser tuberosities to one another as well as the humeral shaft with Ethibond sutures and used the autogenous graft along the humeral stem to enhance potential healing of the repair.  Would the greater and lesser tuberosity fractures be coded separately?  If so, what CPT codes do you recommend?

Thank you for your advice!


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## AlanPechacek (Mar 16, 2016)

*Open Treatment of Proximal Humerus Fracture*

From your query, it appears that your doctor was rendering Open Treatment of a Closed, Displaced, Comminuted 4 Part Fracture of the Proximal Humerus using a Prosthesis (in this case a Reverse Shoulder Prosthesis), plus repair of the Tuberosities, with supplemental bone grafting (source uncertain). As such, you would have to use a Fracture Repair Code, not an Arthroplasty Code, which would be reserved for treatment of a chronic shoulder disorder, not an acute injury/fracture.  Code 23616 is for Open Treatment of Proximal Humerus Fracture, which includes repair of the Tuberosities, and the use of a Prosthesis.  However, this code includes a Proximal Humeral Prosthesis, but not a Reverse Shoulder Prosthesis.  There really isn't a code for what he did.  My best suggestion would be 23616 plus Modifier 22, Increased Procedural Services, and send a copy of the Operative Report as documentation.  Also there is the question of the bone graft, and where it came from.  If he used "Local Bone" harvested from or utilizing bone from the proximal humerus &/or fracture site, then I doubt that there could be any "Extra Charges" for the grafting, and that part would be probably be covered by the Modifier 22.  If, however, he had to harvest bone from another site through a separate incision, and depending on the size/amount/configuration of the bone taken, then a separate procedural code, 20900 or 20902, with Modifier 51 for Multiple Procedure, or possibly 22 again, could be added.  I don't know whether the "New" Modifier 59 would apply, Distinct Procedural Service.  It has gotten so complicated that I would probably lean against using it.  

This gets confusing, but this is the best I can recommend.  I hope it helps.

Respectfully submitted, Alan Pechacek, M.D.


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## cayoung (Mar 18, 2016)

It was a local one graft; so it won't be reported separately. Thank you so very much for your thoughts and perspective.


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