Orthopedic Coding Alert

Can you bill acromioplasty or subscapularis separately? Read on to find out Shoulder surgery has become one of the most popular sub-specialties in orthopedics, and with the proliferation of arthroscopic procedures, many coders are puzzled about exactly how to code the surgeries. Increase your coding accuracy by learning about the anatomy of the shoulder and the specifics of some newer procedures. Get Familiar With Shoulder Anatomy Surgeons often refer to anatomic sites in their op reports, so it can be difficult to select the right codes unless you know your anatomy. This quick primer can help dissolve any coding confusion.
 
The shoulder girdle consists of three joints and two articulations. The joints are 1) the gleno-humeral joint, which is what most people generically refer to as -the shoulder joint,- 2) the acromio-clavicular joint (usually abbreviated to AC joint) and 3) the sterno-clavicular joint (often seen as SC joint). The articulations are classified as such because they are not true synovial joints and are not completely bounded by ligaments. The articulations are 1) the acromial-humeral articulation, more commonly called the sub-acromial space, and 2) the scapulo-thoracic articulation, or the articulation between the ribs and the shoulder blade.
 
Learn the clock-face analogy: Looking at a cross-section of the gleno-humeral joint, surgeons often describe some of their procedures by analogy to a clock face. Thus, you may see -The labrum was torn between 4 and 6 o-clock.-
 
If you imagine a clock face superimposed on the cross-section of the glenoid fossa only, on the right shoulder the anterior aspect of the joint will be from 12 to 6, while on the left shoulder the posterior aspect will be from 12 to 6. The clock face analogy is used to describe tears of the labrum or work done on certain sections of the gleno-humeral joint capsule.
 
The rotator cuff is a series of four muscles that surrounds the gleno-humeral joints -- almost completely. The muscles are the 1) subscapularis, 2) supraspinatus, 3) infraspinatus and 4) teres minor. The subscapularis is the largest muscle and is anterior. The supraspinatus is the muscle most commonly torn and is superior. The infraspinatus and teres minor are the posterior muscles.
 
You may also see the term -the rotator interval.- This is the antero-superior space between the anterior edge of the supraspinatus and the superior edge of the subscapularis, and is the only space where the rotator cuff does not completely invest the gleno-humeral joint.
 
Posteriorly, the interval between the supraspinatus and the infraspinatus is often termed the -posterior rotator interval,- but this is much less discrete. In fact, posteriorly, it is difficult to tell where one muscle starts and one ends when performing arthroscopic surgery. Look at 4 Options When Coding RCRs [...]