Orthopedic Coding Alert

The global surgical package for these surgeries is large.

When the orthopedist performs an arthroscopic shoulder procedure, there will be several other services that could take place during the encounter.

Bad news: Most of these services will be bundled into the surgical package, meaning you cannot report them separately with the shoulder scope codes.

According to Jessyka Burke, BHSA, CPC, COSC, CASCC: “For most shoulder scopes, the following services are included in the global service when provided by the performing provider”:

• Local infiltration of medications, anesthetic, or contrast agent
• Suture or staple removal
• Surgical approach
• Wound specimen obtainment for culture
• Wound irrigation
• Intraoperative photos/videos
• Intraoperative supervision and positioning of imaging/operating equipment
• Insertion/placement/removal of surgical drains, re-infusion devices, irrigation tubes, or catheters
• Closure of wound and repair of tissues divided for surgical exposure
• Application of initial dressing, continuous passive motion, splint, or cast — except where specifically excluded
• Preparation and insertion of synthetic bone substitutes, osteoconductive, and osteoinductive agents — except where specifically excluded
• Diagnostic shoulder arthroscopy (e.g., 29805)
• Synovial resection for visualization
• Manipulation under anesthesia (e.g., 23700)

Exceptions: According to Burke, services not included in the global service package for most shoulder scopes include:

• Supplies and medication (e.g. 99070, other HCPCS level II codes)
• Insertion/removal/exchange of drug delivery implants (e.g., 20700-20705)
• Conscious sedation, regional blocks, Bier blocks

Note: This is merely a guideline for included/excluded services on most shoulder scop procedures. If you have any reservations about one of the above-listed guidelines, check with your payer to make sure you aren’t running afoul of its specific reporting rules.