Orthopedic Coding Alert

Question: How should we code for a shoulder arthroscopy performed with partial claviculectomy (Mumford), repair of labral tear, and anterior capsulorrhaphy?

Michele Little, Greater Cinti Orthopedics
Southgate, KY

Answer: This is an important coding question because CPT does not currently provide combination arthroscopic codes for these procedures. As always, check with your insurance carrier to find out how these cases are to be coded for reporting and reimbursement purposes. However, your office could submit either of the following:

Code 29909 (unlisted procedure, arthroscopy) to report the following: anterior capsulorrhaphy and repair of labral tear assisted by shoulder arthroscopy. The partial claviculectomy (23120) is coded separately as its a separate open incision, which requires the addition of modifier -51 for multiple procedures during the same operative session.

Or, the office could report the arthroscopic assisted anterior capsulorrhaphy and repair of labral tear as 23455 and 29815-51, and use 23120-51 for the open claviculectomy.

The problem with 29815 is that it is a diagnostic arthroscopy code and is a separate procedure, or one that is inherently part of another procedure. Obviously, the major portion of the above surgery was performed via surgical arthroscopy. Thus, the unlisted code 29909 may be your best bet until CPT codes catch up with the procedures you are performing.