Orthopedic Coding Alert

"Complicated arthroscopic shoulder surgeries often result in multiple surgical procedures being performed in the same session. Where it might be easiest simply to match the procedure to the appropriate code, coders need to be aware not only of the codes that best describe what was done, but also what procedures are bundled into other codes.

A Complicated Surgery

Southeast Orthopaedic Institute, a solo-practice orthopedic surgery center in Atlanta, performs surgeries mostly on knees and shoulders. For billing coordinator Peggy Flores, that amounts to numerous coding challenges for the different surgeries performed. The shoulder surgeries in particular are difficult, says Flores, because there are often so many different procedures done at the same time. My main concern is that I might accidentally unbundle the procedures, which in this case seems to be easy to do.

Flores operative report illustrates one of the challenging surgeries. The preoperative diagnosis was for:

1. Rotator cuff tear of the left shoulder (840.4)
2. Labral tear of the left shoulder. (840.8)

The operation consisted of seven different procedures:

1. Arthroscopic labral debridement and repair;
2. Arthroscopic chondroplasty, glenoid;
3. Repair of middle glenohumeral ligament with
ultrasound;
4. Open acromioplasty with coracoacromial ligament
resection;
5. Limited distal clavicle resection;
6. Release of coracohumeral ligament; and
7. Repair of rotator cuff tear.

A Process of Elimination

With a multiprocedure operation like this one, the best way to proceed, according to Heidi Stout, CPC, coding and reimbursement specialist at University Orthopaedic Associates, a multispecialty orthopedic practice in New Brunswick, N.J., is to find the CPT codes that describe each component of the procedure in this case seven codes. After that, says Stout, you can determine which of the codes can be reported together and which should be bundled into other codes, meaning they are considered part of another procedure and therefore not billable separately. Stout, along with James Guerra, MD, VACS, shoulder specialist of Collier Sports Medicine and Orthopedic Center, in Naples, Fla., helps Flores code the surgery.

1. Arthroscopic labral debridement and repair. Stout and Guerra concur that this is essentially an open capsulorraphy and Bankart repair (23455, capsulorraphy, anterior, with labral repair [e.g., Bankart procedure]) done arthroscopically instead of as an open procedure. There is no CPT code that describes this procedure; therefore you should report the unlisted arthroscopy code 29909 (unlisted procedure, arthroscopy). When reporting an unlisted procedure code, supporting documentation must be submitted with the claim. Stout suggests that you submit the operative report along with a letter that describes the procedure in laymans terms and includes information about the time, expertise and special equipment required to provide the service.

2. Arthroscopic chondroplasty, glenoid. When performing a Bankart repair or labral [...]