Diane Posted Wed 31st of July, 2019 18:22:59 PM
Doctor did an open rotator cuff repair, it was shredded along the attachment of the humeral groove with a vertical split all the way to the musculature thus exposing the biceps tendon. Ther remainder of the rotator cuff was stuck to the undersurface of the acromion. An acromioplasty was done. Attempt was made to put in a suture anchor through the tendon but the tendon was so shredded a debridement of the shredded portion was done and discarded, then the biceps tendon was going to be used as a graft which closed the gap over the top of the humeral head . This was an acute injury. The rotator cuff tear code is 23410 but what code do I use for the graft which was the biceps tendon being used as the graft. Dr. dictated, " use of biceps tendon as graft reimforcement." I see no code either under grafts or in the shoulder section. Please advise. Hopefully I will not have to use unlisted. Would this be comsidered shoulder reconstruction 23420? Which I believe includes a graft. Also do I charge for debridement of the shredded rotator cuff? Thank you for your advise.
SuperCoder Answered Thu 01st of August, 2019 10:39:56 AM
As per the above-mentioned report, the surgeon performs a rotator cuff repair, acromioplasty, debridement of the shredded tendon and biceps tendon as graft reinforcement. Generally, rotator cuff repair for acute injury (23410) and acromioplasty (23130) are not performed in same session because its reasons that the acromioplasty was required for the patient's arthritis, a chronic problem unrelated to the injury. CPT codes for rotator cuff repair and acromioplasty will be 23410 and 23130 respectively. Append modifier -52 (Reduced services) to 23130 because you can't recoup the cost of pre- and postoperative care, and opening and closing the patient, in your charges, and bill a lower amount accordingly.
There is no specific code to demonstrate the biceps tendon grafting procedure, so for this procedure unlisted code will be appropriate i.e. 23929. Reporting an unlisted-procedure code will require a special letter of explanation to describe the service to avoid deduction in payment.
For debridement, it will be considered as integral part of rotator cuff repair (23410). You can add modifier 22 with CPT 23410, If you think provider has given extra time for debridement which usually not required. In a separate paragraph, the surgeon should give the specifics of how much more time, skill, or work the procedure required because of the debridement.
On the basis of above-mentioned explanation, the codes for given operative report will be:
Note: CPT 23420 is not an appropriate code as it is only specific for chronic condition.
Hope this helps