Orthopedic Coding Alert

Orthopedic coders consistently cite coding for multiple arthroscopic shoulder procedures as a source of frustration. Too few codes and too many denials cause many coders to expect the worst when it comes to reimbursement. While technological advances in shoulder surgery allow surgeons to perform many procedures arthro-scopically that were formerly done as open procedures, CPT codes do not exist for many of these procedures. Coders must use the unlisted arthroscopy procedure code (29909) to report the surgical services rendered.
A Plan of Attack  
When confronted with an operative report that indicates three, four or more arthroscopic procedures performed in one operative setting, the coder's first instinct may be to put it in the bottom of the "in-box" for another day. Having a game plan to approach a daunting operative report is more proactive. But how does one assign codes for a surgery that lacks CPT codes?
 
Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopedic Associates in New Brunswick, N.J., has an approach that works well for her practice. "When I have an arthroscopic procedure that includes multiple unlisted procedure codes, I first code the procedures as if they were open and list the analog codes that would apply if this were the case," Stout says. Analog codes reflect a similar amount of work and outcome to the procedure in question but do not describe that procedure. Stout then lists the codes by relative value with the highest relative value unit procedure first in descending order. "Next, I check the American Academy of Orthopedic Surgeons (AAOS) Complete Global Service Data Guide to see what procedures are considered components of the primary procedure and go from there," she says.
Surgical Example  
The following operative report illustrates Stout's approach to coding multiple arthroscopies. The patient's preoperative diagnosis was chronic rotator cuff tear of the right shoulder (840.4) and degenerative arthritis in the right acromioclavicular joint. Four procedures were performed:
 
Arthroscopic repair of rotator cuff tear with one side-to-side suture and two Bio-Corkscrew suture anchors;

Arthroscopic biceps tenodesis of right shoulder with one Bio-Corkscrew suture anchor;
 
Arthroscopic acromioplasty, right shoulder and
 
Arthroscopic excision, right distal clavicle.  
If the surgeries had been performed as open repairs, the orthopedist would code 23412 (repair of ruptured musculotendinous cuff [e.g., rotator cuff]; chronic), 23430 (tenodesis of long tendon biceps), 23130 (acromioplasty or acromionectomy, partial, with or without coracoacromial ligament release) and 23120 (claviculectomy; partial).
 
According to the AAOS guide, 23130 is bundled with 23412, but 23430 and 23120 can be reported in addition to 23412. "Armed with this information," Stout says, "calculate an acceptable fee for the procedure by adding the fees for 23412, 23430 and 23120 together." If your practice has a contract with [...]