Orthopedic Coding Alert

Question: Our patient had an apparent scapulotho-racic dislocation (831.0x-831.1x), and the orthopedist examined the left shoulder under general anesthesia and determined that it was in the normal position. He used the C-arm, checked deep tendon reflexes and traced the biceps reflex. We then discontinued anesthesia. How should we code this? Wyoming Subscriber Answer: In your case, it sounds as if the orthopedist did not find a dislocation, nor did he perform a manipulation, so you should report 23929 (Unlisted procedure, shoulder). Submit the operative report with your claim to demonstrate specifically what the orthopedist did while the patient was under anesthesia. Consult the orthopedist to double-check whether he performed a manipulation. If he did, report 23700* (Manipulation under anesthesia, shoulder joint, including application of fixation apparatus [dislocation excluded]). If the orthopedist found a scapular fracture (811.0x-811.1x), report 23585 (Open treatment of scapular fracture [body, glenoid or acromion] with or without internal fixation]). for open treatment. If the orthopedist performs closed fracture treatment, report 23570 (Closed treeatment of scapular fracture; without manipulation) or 23575 (Closed treatment of scapular fracture; with manipulation, with or without skeletal traction [with or without shoulder joint involvement]).


If the orthopedist discovered an acute dislocation, use 23660 (Open treatment of acute shoulder dislocation).