Orthopedic Coding Alert

Question: Our surgeon reports that he did an open lateral deltoid splitting approach for a massive rotator cuff tear, with arthroscopic distal clavicle resection and arthroscopic acromioplasty. How should I code this complicated surgery?

Massachusetts Subscriber  
Answer: When aspects of the procedure are performed open (the rotator cuff repair, in this case) while other aspects are performed arthroscopically (the acromioplasty and distal clavicle resection, in this case), insurance carriers frequently pay on the open procedure and disallow the arthroscopic procedures.
 
This question has recently come before the American Academy of Orthopaedic Surgeons coding committee, which says to report the open rotator cuff repair (23410, 23412 or 23420) and the arthroscopic components of the procedure (29826 or 29824).
 
Modifier -59 (Distinct procedural service) should be appended to 29826 to unbundle the arthroscopic acromioplasty. Code 29824 (Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface [Mumford procedure]) is new for 2002.
 
Carriers have paid for distal clavicle resection in conjunction with rotator cuff repair in the past, so this could be billed as well.