Pick the Right Code for Your Pre-Auth Request
Question: I’m seeking a pre-authorization for a surgical procedure, and I need help finding the correct code. The orthopedist is planning a surgical arthroscopy with lower trapezial transfer for a failed rotator cuff repair. Pennsylvania Subscriber Answer: Use 23395 (Muscle transfer, any type, shoulder or upper arm; single) in your pre-authorization request. This code is appropriate since you’re seeking pre-authorization approval for a single tendon transfer for the shoulder. You may not have an operative note to go by since the physician is merely planning the procedure, so it’s best practice to find the most appropriate code that reflects the future surgery. A pre-authorization approval allows the provider to move forward with performing the procedure understanding that the payer has approved the procedure for a specific time period. Mike Shaughnessy, BA, CPC, Development Editor, AAPC
