Orthopedic Coding Alert

You may be tempted to report an unlisted-procedure code when orthopedic surgeons perform arthroscopic shoulder decompression (SAD) in conjunction with acromioplasty followed by rotator cuff (RTC) repair, but there's a more precise way to code these two procedures.

Orthopedic surgeons often perform arthroscopic shoulder decompressions with acromioplasty, followed by rotator cuff (RTC) repairs through open incisions. Practices that bill for these two procedures together should be sure to use 23412 (Repair of ruptured musculotendinous cuff [e.g., rotator cuff]; chronic) with modifier -59 (Distinct procedural service) appended to 29826 (Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release) instead of using the common but incorrect method of reporting the unlisted-procedure CPT code 29999 (Unlisted procedure, arthroscopy).

According to the American Academy of Orthopaedic Surgeons (AAOS)" codes 23412 and 29826 are billable together with modifier -59 " says Malea Ivy RHIT coder at the Orthopedic and Neurosurgical Center of the Cascades in Bend Ore. "I bill this way all the time and have not been denied yet."

Many practices tell us that their orthopedists perform RTC repairs through a "mini-open incision" to reduce the patient's recovery time and therefore they do not bill separately for it. CPT Code 23412 however can still be billed for the RTC repair despite the size of the incision because the physician is still performing all of the work described in the code descriptor.

Debridement Synovectomy Included in 29806

Many orthopedic coders are tempted to bill separately for arthroscopic capsulorrha-phy debridement and synovectomy when performed together but these three procedures are all grouped into 29806 (Arthroscopy shoulder surgical; capsulorrhaphy) says Beverly Rickord CPC coding supervisor at McLean County Orthopedics in Bloomington Ill. A common operative report reads as follows:

1. Arthroscopic debridement of glenohumeral joint with debridement of partial labral tear fraying and partial synovectomy.

2. Arthroscopic capsular shift of right shoulder with release of SGHL MGHL and manipulation under anesthesia.

Although the surgeon performed several procedures at the same time the only code the orthopedist should report is 29806 Rickord says. "According to the AAOS Complete Global Service Data debridement (29822 Arthroscopy shoulder surgical; debridement limited) and synovectomy (29820 Arthroscopy shoulder surgical; synovectomy partial) are included in 29806."

Even if your practice erroneously reports all three codes your carrier will most likely deny the synovectomy and debridement stating that they are included in the reimbursement for arthroscopy.

Chronic Versus Acute RTC Repairs

Orthopedists sometimes give their coders operative reports for RTC repairs without information about the tear size. Coders should not try to guess the correct code by assuming that a "full thickness" tear refers to three torn muscles/tendons or that a "moderate" tear refers to only one or two. The key to choosing the correct code is to ask the orthopedist precisely how many muscles and/or tendons he or she repaired.

According to the February 2002 CPT Assistant "codes 23410 (Repair of ruptured musculotendinous cuff [e.g. rotator cuff]; acute) and 23412 describe musculo-tendinous cuff repairs involving one or two tendons or major muscles of the rotator cuff." Although 23410 refers to acute repairs 23412 describes repair of a chronic tear.

CPT Assistant advises coders to use 23420 (Reconstruction of complete shoulder [rotator] cuff avulsion chronic [includes acromioplasty]) when orthopedists repair "all three major muscles/tendons of the shoulder cuff."