Orthopedic Coding Alert

Several readers pointed out that the answer to the You Be the Coder question on page 46 of the June 2000 Orthopedic Coding Alert was incorrect. The original question asked for the correct coding for a mini open rotator cuff repair done at the same time as an arthroscopic subacromial decompression and a distal clavicle resection.

We answered that all the procedures were bundled into the distal clavicle resection 23140 (excision with curettage of bone cyst or benign tumor of clavicle or scapula) and that none of the procedures could be coded and billed individually. Blair Filler, MD, FACS, director of medical education at Los Angeles Orthopedic Hospital in California reviewed the original answer and the differing responses from our readers.

Your readers are correct, says Filler. A partial claviculectomy can be coded along with a code for a rotator cuff repair using a -51 modifier (multiple procedures) on the clavicle code. An open chronic rotator cuff repair, by definition, includes an acromioplasty so only code 23420 (reconstruction of complete shoulder [rotator] cuff avulsion, chronic [includes acromioplasty]) can be submitted for these procedures. Filler pointed out, as did several readers, that code 23140 was the wrong code to use for the procedure.

A few readers thought that 23120 (claviculectomy, partial) was the right code to use, but Filler points out that unless a part of the distal clavicle excision was performed through the open incision, it is best to use unlisted code 29909 and append a note stating it is similar to code 23120. Filler continues, If part of the excision of the distal clavicle was through the open wound, then code 23120 is appropriate. The American Academy of Orthopedic Surgeons (AAOS) committee on CPT coding has agreed that excision of 1 cm or more of the distal clavicle is required before use of partial claviculectomy code (23120). Excision of a small osteophyte on the under-surface of the distal clavicle should not be considered a partial claviculectomy.