Wiki Staged shoulder replacement

[suec]

Morning, Has anyone come across a situation, where the shoulder implant was infected and removed. A antibiotic spacer was placed. Now the patient is coming in to have the antibiotic spacer removed and a reverse shoulder replacement. Would this be considered a replacement even though the removal & replacement are not done at the same time? ( CPT 23474) Or is this considered a placement and coded with CPT 23472. This would be for hospital facility coding. Thank you for any input.

 

[amyjph]

Yes.

What do you feel it should be coded as and why? What was coded for the first stage where the implant was removed and the abx spacer implanted?

 

[suec]

I do not know what was coded when the implant was removed and the abx spacer was implanted. My thinking for the revision/ conversion to a reverse is either an initial CPT 23472 because is no implant removed and replaced in the same session. Or CPT 23474-52 because the procedure was done but not the complete procedure. I do not know what your response of Yes means.

 

[amyjph]

Sorry, yes meant I have come across the scenario. I like to ask people's thinking process or what they think it should be coded as before just answering. I don't do facility billing however, there are no conversion codes for the knee and shoulder like there are for the hip (27132). The last guidance I knew of was to code the TSA 23472 and add a 22 for increased services/additional work according to the documentation. It wouldn't be 23474 because the TSA was already removed in the first stage. The first case was probably 23335/20704.
I wish there were codes for the knee and shoulder for this scenario. I see the provider's point where they feel it should be 23474 because the spacer was acting as the temporary joint and a lot of them, like when they do the knee are articulating/functional. In some cases, they even leave the functional spacer in and don't even do another "final" implant. That was one provider's discussion with me, he was like, I can leave this in and it is essentially acting as the final implant even though it is an abx "spacer". The codes have not kept up with the technology and procedures for total joints.
Unfortunately, the 20705 can't be reported with 23472 which makes no sense to me and hasn't since they came out with those drug device codes.

Did you check Coding Clinic or CPT Assistant at all? I don't think there is new guidance, but I have not checked lately.

 

[suec]

Thank you for your explanation. I checked Coding Clinic & CPT Assistant and there this no new guidance.

 

[amyjph]

Thank you for your explanation. I checked Coding Clinic & CPT Assistant and there this no new guidance.

I have seen arguments about articulating versus non-articulating/static spacers too. And, some folks suggest the revision codes should be used for the articulating type even though it's not the "final" implant. I wish there were established codes and/or official guidance. Maybe someone else has info on it.