Wiki Reverse total shoulder for 4 part fracture

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ortho1991

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Hi,

I am looking for help to code this surgery. My phyicain did a reverse total shoulder arthroplasty 23472 for a 4 part fracture he also wants to charge 23410 for repair of rotator cuff and open biceps tenodesis 23430, not sure he can bill for all of these this is NOT A MEDICARE PT but even if it was can we bill all these codes. Any help will be appreciated

Thank you
 
All of those procedures are inclusive to the work of the arthroplasty, eventhough it is not a Medicare patient the NCCI edits are use by most carriers. Unless they have their own edits you have access too such as McKesson edits, we follow the same bundling rules.

Unless the RTC work was performed on the opposite shoulder, then a modifier 59 would apply.
 
23410 and 23430 do bundle with 23472 under NCCI edits, so for Medicare and all carriers following NCCI you can't code those procedures. Check your American Academy of Orthopedic Surgeon GSD. I believe you can code under their guidelines if there is separate pathology for the rotator cuff & biceps tendon.
 
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