Orthopedic Coding Alert

Question: We recently had an audit of our surgical coding and were told that if a tendon is placed into a trough or trench we should be using 23412, not 23420, even when an acromioplasty is performed. What is the difference between 23412 and 23420?

Idaho Subscriber


Answer: For 23410 (repair of ruptured musculotendinous cuff [e.g., rotator cuff]; acute) and 23412 (repair of ruptured musculotendinous cuff [e.g., rotator cuff]; chronic), the rotator cuff tear is either acute or chronic. According to the Coders Desk Reference, for these procedures the supraspinatus tendon is buried in the trench chiseled into the humeral bone, the flap is then fixed with sutures tied to the tendon and passed through holes drilled in the bone. The repair is completed with side-to-side sutures of the supraspinatus to the adjacent subscapularis and infraspinatus tendons. For 23420 (reconstruction of complete shoulder [rotator] cuff avulsion, chronic [includes acromioplasty]) the rotator cuff tear must be a complete or massive tear, and the approach is to reconstruct it, not repair it.

The tear is closed with sutures, and then the under side of the humeral head is removed. The tendon is then brought into contact with raw bone and the ends of the sutures are passed through holes drilled through the greater tuberosity and tied over its lateral aspect.

Hopefully your op reports are detailed so that you can tell the difference and know which code to apply.

According to the AAOS Global Service Data for Orthopaedic Surgery and the Coders Desk Reference, all of these procedures include a acromionectomy or acromioplasty (the underside of the acromion is reduced to allow more room for the rotator cuff tendons), so the acromionectomy or acromioplasty are never billed separately. Also on code 23420, all four components of the rotator cuff must be torn. For 23410 or 23412, one or more of the four components are torn.


Sources for answers to Reader Questions and You Be the Coder are Heidi Stout, CPC, coding and reimbursement specialist at University Orthopaedic Associates, a multispecialty orthopedic practice in New Brunswick, N.J.; Billie Jo McCrary, CPC, CCS-P, CMPC, practice manager of Wellington Orthopaedic and Sports Medicine in Cincinnati, a six-office practice with 18 physicians; and Catherine Brink, principal, HealthCare Resource Management Inc., a medical management consulting firm in Spring Lake, N.J.