Answer: If the surgeon can provide sufficient supporting documentation and thinks his work on the prosthesis went over and above what the arthroplasty normally requires, ask him whether he thinks modifier -22 (Unusual procedural services) is warranted.
If so, you can append modifier -22 to 23472 (Arthroplasty, glenohumeral joint; total shoulder [glenoid and proximal humeral replacement [e.g., total shoulder]) to denote the additional work the surgeon performed.
Include the operative report and a letter with your claim, in which the surgeon should explain that she performed advanced rotator cuff arthroplasty using a "Delta Reverse Total Shoulder Replacement."
She should explain that the patient's condition (such as arthritis with an irreparable rotator cuff tear) was so severe that the Delta prosthesis was a last resort because the patient had no shoulder function.
The surgeon should also include a description of the procedure that she performed and, if applicable, a request for additional reimbursement.
For example, "The surgery required extensive dissection and exposure of the glenoid, then placement of a glenoid component that requires an advanced technique to place. The Metaglene component requires four locking screws that are very difficult to place."