Orthopedic Coding Alert

The shoulder injuries your orthopedist treats can range from unexplained pain on movement to complicated tears and dislocations. If you have trouble distinguishing some of the less serious shoulder conditions, keep this list handy the next time you're assigning a diagnosis.

When the patient's shoulder tendon or bursa becomes pinched or compressed, you're looking at shoulder impingement syndrome. Also known as rotator cuff impingement, you'll report diagnosis 726.10 (Disorders of bursae and tendons in shoulder region, unspecified).

Impingement is common in athletes who perform activities that involve frequent reaching over the head, such as swimming or playing tennis.

Similar, but different: Bursitis and tendinitis are related to shoulder impingement syndrome, and the conditions can occur together.

When your orthopedist diagnoses tendinitis of the shoulder, the patient's rotator cuff and/or biceps tendon are inflamed, which leads to pain and swelling. Shoulder motions during sports, frequent lifting, or other overhead activities might be the culprits.

Assign your diagnosis based on the site of inflammation: 726.10 for an affected rotator cuff or 726.12 (Bicipital tenosynovitis) for an inflamed bicep tendon. Diagnosis 726.11 (Calcifying tendinitis of shoulder) might apply instead if calcium deposits have accumulated in the shoulder tendon.

"No one knows what causes the calcifications," says Bill Mallon, MD, an orthopedic surgeon and medical director of Triangle Orthopaedic Associates in Durham, N.C. "It's not common, but also not extremely rare."

Bursa are fluid-filled sacs that help cushion bones in joints. When the rotator cuff bursa becomes inflamed the patient can develop shoulder bursitis (726.19, Other specified disorders).

Progression: Bursitis can lead to impingement if left untreated, because the swelling and inflammation can cause the tendons and bursa to become pinched between bones. When faced with this situation, simply report the impingement as your diagnosis; including bursitis as a secondary diagnosis could confuse matters, Mallon says.

Whichever of these shoulder conditions ails the patient, your orthopedist will first try conservative treatments such as physical therapy, pain relievers, or shoulder injections (20610, Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]).

Final option: If conservative treatments for any of these conditions fail, the surgeon might suggest subacromial decompression with anterior acrominoplasty to correct the patient's condition to correct the problem.

You'll report the procedure according to the surgical option your orthopedist chooses:

• 29826 -- Arthroscopy, shoulder, surgical;decompression of subacromial space with partial acromioplasty, with or without coracoacromial release

• 23130 -- Acromioplasty or acromionectomy, partial, with or without coracoacromial ligament release

• 23415 -- Coracoacromial ligament release, with or without acromioplasty.