Orthopedic Coding Alert

Question: When a mini open rotator cuff repair is performed at the same time as an arthroscopic subacromial decompression and a distal clavicle resection, is it correct to just bill 23420 and consider the scope procedures as bundled into the open repair code?

My physician wants to use the unlisted code for the clavicle resection (29909), 29826 for the decompression and also an open rotator cuff repair such as 23412. I do not believe all these codes are justified when they are all bundled when an open rotator cuff is performed.

Donna Bal
Midwest Orthopedic Surgery and Surgery Center
Joplin, Mo.

Answer: Your coding is correct. According to the Health Care Financing Administration (HCFA) Correct Coding Initiative, procedures begun as scopes and converted to open are coded as open. In addition, according to the AAOS (American Academy of Orthopedic Surgeons), 23140 (excision or curettage of bone cyst or benign tumor of clavicle or scapula) is included in 23420 (reconstruction of complete shoulder [rotator] cuff avulsion, chronic [includes acromioplasty]) as well as the clavicle resection.