Orthopedic Coding Alert

Question: How do we code for a shoulder arthroscopy performed with a rotator cuff repair? Our insurance companies deny this claim.

Vicki Schenigt, Insurance Clerk
Carolina Orthopaedic Clinic, Orangeburge, SC

Answer: Payers are denying the claim because a shoulder arthroscopy is considered an inherent part of a 23410 (repair of rupture musculotendinous cuff). Such bundled codes should not be unbundled and billed separately.

A shoulder arthroscopy should only be billed when it is done as a separate procedure in order to diagnose, not when it merely serves to expedite the performance of another procedure.

Note: Even though you wont find this edit listed in the National Correct Coding Initiative (CCI), dont rationalize the unbundling. Remember the CCI only includes code combinations that are not already designated as bundled according to CPT guidelines.

To highlight the unbundling issues for orthopedists, the American Academy of Orthopedic Surgeons (AAOS) has published a book containing intraoperative global service dataThe Complete Global Service Data for Orthopedic Surgery. Theyve also issued a position statement that reads, The AAOS believes it is unethical for orthopedic surgeons to separate from the global service package services, which are a necessary part of the surgical procedure and then bill individually for those services.