Get Paid for Arthroscopic-to- Open Shoulder Surgeries
Published on Fri Dec 01, 2000
As more and more orthopedic surgeons embrace arthroscopy as the most effective tool for diagnosing and treating shoulder pathology, reimbursement issues arise when the procedure cannot be completed arthroscopically. Although arthroscopy is an additional step that ensures a fully visualized surgical area, carriers are usually unwilling to reimburse surgeons for both the open and arthroscopic portions of a surgical procedure.
Changing Procedures
A typical arthroscopic shoulder surgery is coded with CPT 29826 (arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release). The orthopedist may consider performing the entire procedure arthroscopically with the knowledge that an open repair may be required. The view through the arthroscope does indeed reveal that a rotator cuff repair (23410, repair of ruptured musculotendinous cuff [e.g., rotator cuff]; acute) is required. The surgery then switches from an arthroscopic approach to an open repair.
Another typical scenario occurs when the orthopedist uses the arthroscope to attain an enhanced view of the operative site. Arthroscopically, the surgeon can better visualize the intra-articular structures of the shoulder joint. This is particularly true in cases of suspected rotator cuff damage. The two spaces of the rotator cuff, the glenohumeral (undersurface of rotator cuff) and the bursa superior (top of the rotator cuff), are clearly visible through the arthroscope. If the surgeon relies solely on the view afforded through the open procedure, he or she might not have as clear an idea of the work required to repair the damage.
For example, a patient with a history of an acute shoulder dislocation suffers a subsequent injury to the shoulder with recurrent subluxations. X-rays are negative. The surgeon performs a diagnostic arthroscopy to assess the shoulder pathology. This arthroscopic examination of the shoulder reveals that the subscapularis and bicep tendons are normal and the rotator cuff is intact, as are the superior, middle and inferior glenohumeral ligaments. No loose bodies are visualized, but the anterior glenoid labrum is torn and completely detached. At this point the surgeon determines that an anterior capsulorrhaphy with labral repair (23455, capsulorrhaphy, anterior; with labral repair [e.g., Bankart procedure]) is necessary. The arthroscope is removed, and the open procedure begins.
The question then becomes how to code and obtain reimbursement for both the diagnostic arthroscopy (29815, arthroscopy, shoulder, diagnostic, with or without synovial biopsy [separate procedure]) and the Bankart procedure (23455).
No Sure Path to Reimbursement
Susan Callaway, CPC, CCS-P, an independent coding consultant and educator based in North Augusta, S.C., who has extensive experience in orthopedics, explains that when any procedure is started arthroscopically and switches to an open procedure, the open procedure should be billed.
The first issue is, if you start with a scope repair and [...]
