Wiki Total Reverse Shoulder Arthroplasty

[hanoz420@hotmail.com]

One of our Ortho docs did a Total Reverse shoulder arthroplasty....I'm coding it to a 23472-22 and a 23331. The pre and post op dx states Failed hemiarthroplasty......can't seem to locate the proper ICD9...can anyone assist me with this?

 

[AuntJoyce]

Reverse total shoulder...

Before you go that route, consider 23929 being submitted with the op report...and your adjusted fee and then consider 996.77 or 996.40 - just some places to visit and ponder...

Good luck,

Joyce

 

[mbort]

Before you go that route, consider 23929 being submitted with the op report...and your adjusted fee and then consider 996.77 or 996.40 - just some places to visit and ponder...

Good luck,

Joyce

I disagree with the use of an unlisted code for a reverse total shoulder. The codes that were chosen by the original poster were correct (assuming they have the documentation that supports both codes).

This is from AAOS:
Reverse total shoulder arthroplasty

Q. What CPT code would you report when performing a reversal total shoulder arthroplasty?

A. CPT will, at times, have one code that covers a particular procedure such as arthroplasty. Different techniques are then developed to either enhance or strengthen the procedure. But when it comes to coding, the procedure is still considered an arthroplasty. If the surgeon is able to document more extensive work or unusual circumstances such as an altered surgical field from prior injury, surgery or extensive scarring, modifier –22 may be considered when assigning 23472.

http://www2.aaos.org/aaos/archives/bulletin/apr06/coding2.asp

I would choose from the 996.XX series for the appropriate dx code.

 

[kamiles]

Before you make a final decision you should always check with the patient's medical payer for a medical policy. BCBS of IL (HCSC) medical policy for reverse shoulder arthoplasty (medical policy SUR705.031) states to bill CPT code 23929, ICD-9 codes 716.11, 996.40-996.49, and ICD-9 procedure code 81.80.