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Orthopedic Coding Alert

Reader Questions:

Choose Between Acute, Chronic for RTC Repairs

Question: Our surgeon performed an open rotator cuff repair, subacromial decompression, and distal clavicle excision. Which codes should we report?

New Jersey Subscriber
Answer: Depending on the patient's condition, you should choose from one of the following three codes for the rotator cuff repair:
  23410 - Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; acute
  23412 - ... chronic
  23420 - Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromio-plasty). Orthopedic surgeons report that most patients who require this type of surgery have chronic conditions, so 23412 or 23420 is likely the appropriate code. But you should check the surgeon's documentation to determine which type of rotator cuff injury the patient had.

If the patient had a chronic condition, determine whether the surgeon repaired (23412) or reconstructed (23420) the rotator cuff.

You should report 23120 (Claviculectomy; partial) for the distal clavicle excision.

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