Orthopedic Coding Alert

Question: Our surgeon completed an arthroscopic SLAP repair, acromioplasty, and distal clavicle excision. Then he converted to an open procedure to perform rotator cuff repair. Is there any way to recoup for all the arthroscopic work before the open repair?

Colorado Subscriber

Answer: Because the surgeon shifted from arthroscopic to open techniques to complete different procedures, you can code for everything. Report the rotator cuff repair with 23410 (Repair of ruptured musculotendinous cuff [e.g., rotator cuff] open; acute) or 23412 (...chronic) as appropriate. Then code each of the arthroscopic procedures with modifier 59 (Distinct procedural service).

Guideline: If the surgeon converts from an arthroscopic to open approach for the same procedure during a session, you'll only code the open approach. For example, he might start with the scope to perform debridement for better visualization, then convert to an open approach for the primary procedure. In that case, the scope work is included in the overall procedure.