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Shoulder Hemi & Revision in One Surgery

Kirsten Posted Mon 22nd of June, 2015 14:52:21 PM

The patient came to my Doc with a hemi of the shoulder which had failed. So my Doc took her to the OR and performed a revision of the humeral stem and glenosphere. Then he performed a primary hemi arthroplasty of the glenoid. I felt the most appropriate codes would be 23473 for the humerus, and 23470 for the glenoid. However, CCI edits says you can do it with the appropriate modifier. Is an XS modifier appropriate for the glenoid only?

SuperCoder Answered Tue 23rd of June, 2015 00:46:02 AM

As patient had Hemiarthroplasty of shoulder and doctor converted it into a total shoulder replacement by replacing both humeral and glenosphere component and surface respectively. This procedure qulaify for total shoulder replacement procedure. Use CPT code 23472. As per CCI guidelines "CPT codes 23470 (arthroplasty, glenohumeral joint; hemiarthroplasty) and 23472 (arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder)) include removal of native joint or a failed prosthesis and replacement with a new prosthesis. CPT codes 23333(removal of foreign body, shoulder; deep (subfascial or intramuscular)), 23334 (removal of prosthesis, includes debridement and synovectomy when performed; humeral or glenoid component), or 23335 (removal of prosthesis, includes debridement and synovectomy when performed; humeral and glenoid components (eg, total shoulder)) should not be reported separately with CPT codes 23470 or 23472 for removal of a prior failed prosthetic joint.
CMS considers the shoulder joint to be a single anatomic structure. An NCCI procedure to procedure edit code pair consisting of two codes describing two shoulder joint procedures should never be bypassed with an NCCI-associated modifier when performed on the ipsilateral shoulder joint. This type of edit may be bypassed only if the two procedures are performed on contralateral joints."

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